University Children's Hospital, Faculty of Medicine University of Belgrade, Belgrade, Serbia.
Allergy and Clinical Immunology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Pediatr Allergy Immunol. 2019 May;30(3):269-276. doi: 10.1111/pai.13034.
Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life-threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug-induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non-steroidal anti-inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate-onset drug-induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children.
药物过敏反应（DHR）是一个主要且常见的公共卫生问题，尤其在儿童中更为常见。DHR 最严重的表现之一是过敏反应，可能会危及生命。在过去的几十年中，过敏反应受到了特别多的关注，最近还发布了国际共识指南。虽然药物引起的过敏反应在成年人群中更为常见，但对于药物在儿童过敏反应中的作用知之甚少。β内酰胺类抗生素和非甾体抗炎药是最常涉及的药物，这可能与高处方率有关。诊断依赖于对症状模式的识别，并基于完整的过敏检查，特别是包括皮肤试验和/或特异性 IgE。然而，对于许多药物，这些测试在诊断儿童即时反应方面的实际诊断价值仍未得到很好的定义。一般来说，讨论药物激发试验以确认或排除即刻发生的药物诱导的过敏反应。尽管避免使用可疑药物（和相关药物）是常规做法，但在选定的患者亚组中，快速脱敏是有用的。需要进行大型、多中心研究，以评估目前可用的皮肤试验的实际诊断价值。此外，未来还需要开发新的诊断测试，以改善这些儿童的管理。
