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
. 2022 Jan 1;50(1):104-107.
doi: 10.15586/aei.v50i1.382. eCollection 2022.

Drug reexposure in children with severe mucocutaneous reactions

Luis Moral  1 , Teresa Toral  2 , Ana Gilabert  3 , Ares Sánchez  3 , Juan Francisco Silvestre  4 , Francisco Manuel Marco  5
Affiliations

Drug reexposure in children with severe mucocutaneous reactions

Luis Moral et al. Allergol Immunopathol (Madr). .

Abstract

In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk-benefit balance, preceded by a sequential study including in vitro and skin tests.

Keywords: Allergy Workup; Children; Drug Provocation Test; Nonsteroidal Anti-inflammatory Drugs; Severe Cutaneous Adverse Reaction.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no potential conflicts of interest with respect to research, authorship, and/or publication of this article.This research received no specific grants from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that they have no conflicts of interest, financial relationships, or funding sources relevant to this article.

References

    1. 1. Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al. Drug hypersensitivity in children: Report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016;71(2):149–61. 10.1111/all.12774 - DOI
    1. 2. Liccioli G, Mori F, Parronchi P, Capone M, Fili L, Barni S, et al. Aetiopathogenesis of severe cutaneous adverse reactions (SCARs) in children: A 9-year experience in a tertiary care paediatric hospital setting. Clin Exp Allergy. 2020;50(1):61–73. 10.1111/cea.13513 - DOI
    1. 3. Abreu S, Castelblanco-Arango IY, Gómez-Pineda PA, Cardona R. Drug provocation tests to identify analgesic alternatives for an infant with Stevens-Johnson syndrome caused by ibuprofen-acetaminophen. Rev Alerg Mex. 2020;67(2):189–95. 10.29262/ram.v67i2.712 - DOI
    1. 4. Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, et al. ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson syndrome and toxic epidermal necrolysis: Comparison with case-control analysis. Clin Pharmacol Ther. 2010;88(1):60–8. 10.1038/clpt.2009.252 - DOI
    1. 5. Liccioli G, Filippeschi C, Giovannini M, Capone M, Oranges T, Barni S, et al. Mycoplasma pneumoniae-associated mucocutaneous disease in children: A case series with allergy workup in a tertiary care paediatric hospital. Clin Exp Allergy. 2021;51(5):740–4. 10.1111/cea.13861 - DOI

LinkOut - more resources