Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy.
Ital J Pediatr. 2020 Jan 10;46(1):5. doi: 10.1186/s13052-019-0753-4.
Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs.
The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines.
Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs.
Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.
药物过敏反应（DHRs）被认为是类似于过敏症状的药物不良反应。据报道，儿科药物反应的阳性临床病史约为 10%，然而，经过过敏调查，只有一小部分被确认为过敏。本研究旨在分析因疑似 DHR 而被转至我院过敏科的儿童和青少年的临床病史、过敏检查结果和致敏谱。
该研究评估了在两年期间内一组有药物反应阳性病史的患者的数据。过敏检查包括体内和体外检查，符合 ENDA/EAACI 指南的建议。
回顾性分析了一组 637 名患者的数据[348 名男性（54.6%）；289 名女性（45.4%）]。报告的临床病史中最常见的药物是β内酰胺类（BLs），其次是非甾体抗炎药（NSAIDs）。BL 治疗时最常观察到严重皮肤不良反应（SCARs）。立即反应（IRs）的 BL 过敏确认率较高[9.4%；5.1%通过皮肤点刺试验（STs）和 5.5%通过药物激发试验（DPT）]，而非立即反应（non-IRs）的确认率较低[8.1%；2.2%通过 STs 和 6.2%通过 DPT]。在索引反应后 12 个月内进行 BL 和大环内酯类药物检查时，阳性结果的数量更多（p<0.05）。在阿莫西林-克拉维酸的 DPT 中，尽管 STs 为阴性，但仍发生了 4 例过敏反应（包括 1 例过敏反应）。
我们的数据表明，只有 9.1%的患者对过敏测试呈阳性，这与文献中的数据一致。为了排除疑似过敏，必须进行过敏检查。
