Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Feb;33(2):e13719.
doi: 10.1111/pai.13719.

The controversy of drug hypersensitivity in patients with cystic fibrosis and review of the literature

Gokcen Dilsa Tugcu  1 , Nagehan Emiralioglu  1 , Ebru Yalcin  1 , Umit Murat Sahiner  2 , Deniz Dogru  1 , Bulent Enis Sekerel  2 , Ugur Ozcelik  1 , Nural Kiper  1 , Ozge Soyer  2
Affiliations
Review

The controversy of drug hypersensitivity in patients with cystic fibrosis and review of the literature

Gokcen Dilsa Tugcu et al. Pediatr Allergy Immunol. 2022 Feb.

Abstract

Background: Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in children with CF.

Methods: The suspicious drug hypersensitivity reactions (DHRs) of children with CF were enquired by the European Network for Drug Allergy (ENDA) questionnaire, and skin tests and/or drug provocation tests were performed according to the established guidelines.

Results: Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, among which 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were of non-immediate (n = 16, 66.6%) type, and the offending drugs were amoxicillin-clavulanic acid (n = 7), macrolides (n = 4), trimethoprim-sulfamethoxazole (TMP/SMX) (n = 2), piperacillin-tazobactam (n = 1), pancrelipase (n = 1), and ursodeoxycholic acid (n = 1). Eight (33.3%) of the DHRs were classified as immediate (ceftriaxone [n = 2], ceftazidime [n = 2], meropenem [n = 1], AmBisome [n = 2], and vancomycin [n = 1]). The main clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%), and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed, and none of the skin tests revealed a positive result; however, 2 DPTs with TMP/SMX were positive.

Conclusion: Actual drug hypersensitivity was demonstrated in 2 of 219 patients (0.9%) with non-beta-lactam antibiotics. These results conflict with previous researches that showed higher drug hypersensitivity rates but are consistent with some recent studies. Allergological diagnostic workup is mandatory in patients with cystic fibrosis in case of a suspicious DHR.

Keywords: actual drug allergy; challenge tests; cystic fibrosis; drug hypersensitivity reactions; skin prick tests.

PubMed Disclaimer

References

REFERENCES

    1. Villanueva G, Marceniuk G, Murphy MS, Walshaw M, Cosulich R, Guideline C. Diagnosis and management of cystic fibrosis: summary of NICE guidance. BMJ. 2017;359:j4574.
    1. Bell SC, Mall MA, Gutierrez H, et al. The future of cystic fibrosis care: a global perspective. Lancet Resp Med. 2020;8(1):65-124.
    1. Castellani C, Duff AJA, Bell SC, et al. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros. 2018;17(2):153-178.
    1. Konstan MW, VanDevanter DR, Sawicki GS, et al. Association of high-dose ibuprofen use, lung function decline, and long-term survival in children with cystic fibrosis. Ann Am Thorac Soc. 2018;15(4):485-493.
    1. McCrory BE, Harper HN, McPhail GL. Use and incidence of adverse effects of proton pump inhibitors in patients with cystic fibrosis. Pharmacotherapy. 2018;38(7):725-729.