Diagnosing Single and Multiple Drug Hypersensitivity in Children: A Tertiary Care Center Retrospective Study

Abstract

Drug hypersensitivity reactions (DHRs) are a type of adverse drug reactions with heterogeneous pathophysiological mechanisms and a broad spectrum of clinical manifestations. Since over-diagnosing is common in children, a complete allergy work-up is needed. A cross-sectional study was conducted at a tertiary care institution, covering the five-year period. Five hundred and four patients of both sexes, mean age 7.5 and with a medical history suggestive of DHR were evaluated. ENDA/EAACI guidelines were used for a diagnostic algorithm. Single drug hypersensitivity was registered in 375 patients and multiple drug hypersensitivity in 129. The main culprits in medical history were antibiotics (83%), non-steroidal anti-inflammatory drugs (NSAIDs) (8.4%) and analgoantipyretics (3.8%). Skin involvement was registered in 96.2%. DHRs were confirmed in 4.4% patients-six patients had positive skin tests and 13 had a positive drug provocation test. In the proven DHRs group, the main agents were antibiotics (72.7%), followed by NSAIDs (8.3%), and of all the skin manifestations, urticaria was most common (78.2%), followed by exanthema (10.5%) and angioedema (5.3%). Considering the above, anticipating DHRs and a proper referral of children to an allergologist is a key step in the assessment of drug hypersensitivity. A complete allergy work-up prevents unnecessary drug exclusion and allows most children to safely continue the use of first-line medications when needed.

Keywords: allergy diagnostic algorithm; antibiotics; children; cutaneous manifestations; multiple drug hypersensitivity.

Figure 1

Suspected DHRs to specific drug classes (data obtained from patients’ medical histories). DHRs—Drug hypersensitivity reactions; SS penicillins—semi-synthetic penicillins; NSAIDs—non-steroidal anti-inflammatory drugs; GA—general anesthetics; NMBA—neuromuscular blocking agents; TMP-SMX—trimethoprim-sulfamethoxazole.

Figure 2

Ratio between proven and excluded DHRs. DHRs—Drug hypersensitivity reactions; SS penicillins—semi-synthetic penicillins; NSAIDs—non-steroidal anti-inflammatory drugs; GA—general anesthetics; NMBA—neuromuscular blocking agents; TMP-SMX—trimethoprim-sulfamethoxazole.