Cavkaytar Ozlem, Karaatmaca Betül, Cetinkaya Pınar Gur, Esenboga Saliha, Arik Yilmaz Ebru, Sahiner Umit M, Sekerel Bulent E, Soyer Ozge
Allergy Asthma Proc. 2017 Sep 1;38(5):56-63. doi: 10.2500/aap.2017.38.4064.
Although data on anaphylaxis in the general population exist for different allergens, there is still lack of detailed etiologic data on drug-induced anaphylaxis (DIA), particularly in children.
To define the etiology of DIA, to determine the accuracy of drug-related anaphylaxis histories, along with the severity and culprit drug associations among individuals <18 years old.
Patients with a history of drug hypersensitivity reaction (DHR) referred to our center between January 2012 and February 2016 were included. After the collection of European Network for Drug Allergy questionnaire results, initial skin tests and/or provocation tests were performed for the offending drug.
Among 561 children and adolescents referred due to a suspected DHR, 113 (19%) (median age [interquartile range], 9.6 years [5.4-13.8 years]; 55% boys) had anaphylaxis in their history. At the end of diagnostic evaluation of the patients, 84 (74% of the patients with a history of DIA) were actually hypersensitive to the offending drug. Major drugs that resulted in DIA were antibiotics (33%), nonsteroidal anti-inflammatory drugs (25%), and chemotherapeutics (19%). The majority of patients reported grade 2 (moderate) (45%) and grade 3 (severe) (33%) anaphylactic reactions. A history of systemic illness (41.7 versus 7.1%; p = 0.001), concomitant intake of other drugs regularly (36.9 versus 10.3%; p = 0.007), and the use of chemotherapeutics as the culprit drug (19 versus 0%; p = 0.011) were more frequent, whereas the use of antibiotics was less frequent (34.5 versus 75.9%; p < 0.001) among patients with actual DIA compared to drug tolerant patients.
Three-fourths of the children and adolescents referred due to a suspected history of DIA were found to actually be drug hypersensitive. Prediagnosed systemic illness and different types of drugs would have an impact on the risk of DIA; however, atopic disease or a family history of drug hypersensitivity did not have an impact on actual DIA.
尽管普通人群中存在不同过敏原引起过敏反应的数据，但药物性过敏反应（DIA），尤其是儿童的药物性过敏反应，仍缺乏详细的病因数据。
明确DIA的病因，确定药物相关过敏反应病史的准确性，以及18岁以下个体的过敏反应严重程度和可疑药物关联。
纳入2012年1月至2016年2月间转诊至本中心的有药物过敏反应（DHR）病史的患者。收集欧洲药物过敏网络问卷结果后，对可疑药物进行初始皮肤试验和/或激发试验。
在因疑似DHR转诊的561名儿童和青少年中，113名（19%）（中位年龄[四分位间距]，9.6岁[5.4 - 13.8岁]；55%为男孩）有过敏反应病史。在患者诊断评估结束时，84名（有DIA病史患者的74%）实际对可疑药物过敏。导致DIA的主要药物为抗生素（33%）、非甾体抗炎药（25%）和化疗药物（19%）。大多数患者报告为2级（中度）（45%）和3级（重度）（33%）过敏反应。与药物耐受患者相比，实际发生DIA的患者中，全身性疾病病史（41.7%对7.1%；p = 0.001）、经常同时服用其他药物（36.9%对10.3%；p = 0.007）以及使用化疗药物作为可疑药物（19%对0%；p = 0.011）更为常见，而使用抗生素则较少见（34.5%对75.9%；p < 0.001）。
因疑似DIA病史转诊的儿童和青少年中，四分之三实际对药物过敏。预诊断的全身性疾病和不同类型的药物会对DIA风险产生影响；然而，特应性疾病或药物过敏家族史对实际的DIA没有影响。
