Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Immun Inflamm Dis. 2018 Mar;6(1):3-12. doi: 10.1002/iid3.201. Epub 2017 Nov 1.
Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the differences in clinical characteristics and management of DIA between adults and children.
We assessed the percentage, diagnosis, and management of DIA among all anaphylaxis visits in three pediatric and one adult emergency departments (ED) across Canada.
Children presenting to the Montreal Children's Hospital (MCH), British Columbia Children's Hospital (BCCH), and Children's Hospital at London Health Sciences Center and adults presenting to Hôpital du Sacré-Coeur with anaphylaxis were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized data form documenting the reaction and management was completed and patients were followed annually to determine assessment by allergist and use of confirmatory tests.
From June 2012 to May 2016, 51 children were recruited from the pediatric centers and 64 adults from the adult center with drug-induced anaphyalxis. More than half the cases were prospectively recruited. The percentage of DIA among all cases of anaphylaxis was similar in all three pediatric centers but higher in the adult center in Montreal. Most reactions in children were triggered by non-antibiotic drugs, and in adults, by antibiotics. The majority of adults and a third of children did not see an allergist after the initial reaction. In those that did see an allergist, diagnosis was established by either a skin test or an oral challenge in less than 20% of cases.
Our results reveal disparities in rate, culprit, and management of DIA in children versus adults. Further, most cases of suspected drug allergy are not appropriately diagnosed. Guidelines to improve assessment and diagnosis of DIA are required.
关于药物诱发的过敏反应（DIA）的数据很少，目前还没有研究评估成人和儿童之间 DIA 的临床特征和管理差异。
我们评估了加拿大三个儿科和一个成人急诊部（ED）所有过敏反应就诊中 DIA 的百分比、诊断和管理。
在蒙特利尔儿童医院（MCH）、不列颠哥伦比亚省儿童医院（BCCH）和伦敦健康科学中心儿童医院就诊的出现过敏反应的儿童以及在 Sacré-Coeur 医院就诊的成人作为跨加拿大过敏反应登记处的一部分被招募。记录反应和管理的标准化数据表格完成后，每年对患者进行随访以确定过敏专家的评估和使用确证测试。
从 2012 年 6 月至 2016 年 5 月，从儿科中心招募了 51 例儿童和成人中心的 64 例成人，这些儿童和成人患有药物诱发的过敏反应。超过一半的病例是前瞻性招募的。在所有过敏反应病例中，DIA 的百分比在所有三个儿科中心相似，但在蒙特利尔的成人中心更高。大多数儿童的反应是由非抗生素药物引发的，而成人的反应是由抗生素引发的。大多数成人和三分之一的儿童在初始反应后没有看过敏专家。在那些看过敏专家的人中，不到 20%的病例通过皮肤试验或口服挑战确定了诊断。
我们的研究结果揭示了儿童与成人之间 DIA 的发生率、病因和管理方面的差异。此外，大多数疑似药物过敏的病例没有得到适当诊断。需要制定指南以改善 DIA 的评估和诊断。
