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. 2020 Jan 10;46(1):5.
doi: 10.1186/s13052-019-0753-4.

Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

A Piccorossi  1 , G Liccioli  2 , S Barni  3 , L Sarti  3 , M Giovannini  3 , A Verrotti  1 , E Novembre  3 , F Mori  3
Affiliations

Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

A Piccorossi et al. Ital J Pediatr. .

Abstract

Background and objective: Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs.

Methods: The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines.

Results: Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs.

Conclusion: Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Keywords: Allergy tests; Drug hypersensitivity reaction; Epidemiology; Pediatrics.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Drugs involved in a history of referred reactions (absolute numbers)
Fig. 2
Fig. 2
Allergy work-up results for the main drug classes: betalactams immediate-reactions IRs: immediate reactions; Non-IRs: non-immediate reactions; STs: Skin tests; DPTs: drug provocation tests; Alt: alternative drug; NSAIDs: Non-steroidal anti-inflammatory drugs; ASA: acetylsalicylic acid; COX: cyclooxygenase; U/A: urticaria/angioedema; SCAR: Severe Cutaneous Adverse Reactions; DRESS: Drug Reaction with Eosinophilia and Systemic Symptoms; SSLR: Serum Sickness–Like Reaction; SJS: Stevens-Johnson syndrome; THR: thrombocytopenia; GI: gastrointestinal; neg: negative; POS: positive; n.p.: not performed
Fig. 3
Fig. 3
Betalactams non-immediate reactions
Fig. 4
Fig. 4
Macrolides
Fig. 5
Fig. 5
Non-steroidal anti-inflammatory drugs
Fig. 6
Fig. 6
Other drugs
See this image and copyright information in PMC

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