Department of Pediatric Allergy and Immunology, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Pediatric Infectious Diseases, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Int Arch Allergy Immunol. 2018;176(1):33-38. doi: 10.1159/000481988. Epub 2018 Apr 4.
The incidence of rash after aminopenicillin treatment in children with Epstein-Barr Virus (EBV) infection was reported to be 80-100%. A few recent studies suggested that the incidence may be much lower during EBV infection. There are no clear data on the incidence of true drug hypersensitivity among these patients. The aim of this study is to determine the incidence of rash and antibiotic allergy after antibiotic treatment in children with EBV infection.
Drug hypersensitivity was investigated in antibiotic-treated patients with a positive EBV IgM who developed a rash between 2013 and 2016.
During the study period, 221 children were diagnosed with EBV infection, and 120 (54.3%) patients were treated with antibiotics during disease. Rash developed in 41 (41/221, 18.6%) patients, and 20 of them (total 120; 16.6%) were treated with antibiotics (most frequently aminopenicillins: 72.5%), and 21 of them (total 101, 20.8%) were not treated with antibiotics (p = 0.43). For 10 of the 20 antibiotic-treated patients with a rash, parents did not consent to an allergy workup. Three of the 10 patients who were tested for drug allergy were proven to have amoxicillin-clavulanate hypersensitivity (30%). Five of the patients without workup reacted after reuse of the suspected drug for infection treatment.
In this study, the incidence of drug hyper-sensitivity was much lower than previously reported. Some of the reactions that occur during infectious mononucleosis are transient, and some are true drug hypersensitivity reactions. Thus, these patients should be evaluated with allergy tests before these drugs are used again after EBV infection.
有报道称，儿童在感染 EBV 后使用氨基青霉素治疗皮疹的发生率为 80-100%。最近的一些研究表明，在 EBV 感染期间，该发生率可能低得多。对于这些患者，真正的药物过敏反应发生率尚无明确数据。本研究旨在确定 EBV 感染儿童在抗生素治疗后皮疹和抗生素过敏的发生率。
对 2013 年至 2016 年间发生皮疹的 EBV IgM 阳性抗生素治疗患者进行药物过敏调查。
研究期间，221 例儿童被诊断为 EBV 感染，120 例（54.3%）患者在疾病期间接受了抗生素治疗。41 例（221 例患者中的 41 例，18.6%）出现皮疹，其中 20 例（120 例患者中的 20 例，16.6%）接受了抗生素治疗（最常使用的是氨基青霉素：72.5%），而 21 例（101 例患者中的 21 例，20.8%）未接受抗生素治疗（p = 0.43）。对于 20 例接受抗生素治疗且出现皮疹的患者中，有 10 例的家长不同意进行过敏检查。在接受药物过敏检查的 10 例患者中，有 3 例证实对阿莫西林-克拉维酸过敏（30%）。在未进行检查的 5 例患者中，再次使用可疑药物治疗感染时出现了反应。
在本研究中，药物超敏反应的发生率远低于之前的报道。在传染性单核细胞增多症期间发生的一些反应是短暂的，而另一些则是真正的药物过敏反应。因此，在 EBV 感染后再次使用这些药物之前，应通过过敏试验对这些患者进行评估。
