Department of Obstetrics and Gynecology, Hôpital Saint Joseph, FR-13008, Marseille, France.
Department of Pediatrics, Hôpital Saint Joseph, FR-13008, Marseille, France.
Eur J Pediatr. 2021 Feb;180(2):495-503. doi: 10.1007/s00431-020-03859-2. Epub 2020 Nov 6.
Our objective was to describe and discuss management of recent cases of drug hypersensitivity in children reported in a pharmacovigilance center. Two pediatric allergy units conducted a collaborative retrospective analysis of 101 adverse drug reactions reported to a regional pharmacovigilance center between January 2016 and July 2019. Time lapse between hypersensitivity reaction onset and allergy consultation varied from 1 month to 12 years. Sixty-two patients (61.4%) presented with immediate reactions, 11 (10.9%) with non-immediate reactions, and 28 (27.7%) had reactions impossible to classify through medical interview. Overall, 92 children (91%) were explored for simultaneously administered drugs. All 113 prick tests were negative, and 2 were uncertain. Among 108 intradermal tests, 2 were positive to penicillin and to an iodinated contrast medium, 105 were negative, and 1 was uncertain. Overall, 129 drug provocation tests were proposed. Nine provocation tests among 80 were positive (11.25%): 6 to penicillin, 1 to sulfonamide antibiotics, and 2 to non-steroidal anti-inflammatory drugs; the remaining 71 were negative. No severe reaction was observed during these tests. Finally, drug allergy was only retained in 11 reported cases (10.9%).Conclusion: These pharmacovigilance reports show the difficulty in defining drug allergy in children only by anamnesis, and that explorations, particularly provocation tests, should take place at a reasonable time lapse after drug hypersensitivity reaction onset. What is Known: • True drug allergy is rarely observed in children. • Absence of full workup leads to falsely labeling children as "allergic." What is New: • Short time lapse between hypersensitivity onset and consultation improves classification of pediatric allergy. • Timely allergy consultations are essential, and tests are useful to confirm or exclude pediatric allergy.
我们的目的是描述和讨论在一个药物警戒中心报告的最近几例儿童药物过敏反应的处理方法。两个儿科过敏单位对 2016 年 1 月至 2019 年 7 月期间向区域药物警戒中心报告的 101 例药物不良反应进行了合作回顾性分析。过敏反应发作和过敏咨询之间的时间间隔从 1 个月到 12 年不等。62 例患者（61.4%）表现为即刻反应，11 例（10.9%）为非即刻反应，28 例（27.7%）通过医疗访谈无法对反应进行分类。总体而言，92 例儿童（91%）同时进行了药物探索。所有 113 点刺试验均为阴性，2 个结果不确定。在 108 个皮内试验中，2 个对青霉素和碘造影剂呈阳性，105 个为阴性，1 个结果不确定。总体而言，提出了 129 个药物激发试验。在 80 例中有 9 例（11.25%）激发试验阳性：6 例为青霉素，1 例为磺胺类抗生素，2 例为非甾体抗炎药；其余 71 例为阴性。在这些试验中没有观察到严重反应。最后，只有 11 例报告病例（10.9%）保留了药物过敏。结论：这些药物警戒报告表明，仅通过病史很难在儿童中确定药物过敏，应在药物过敏反应发作后合理的时间间隔内进行探索，特别是激发试验。已知：·儿童中很少观察到真正的药物过敏。·未进行全面检查会导致错误地将儿童标记为“过敏”。新发现：·过敏反应发作和咨询之间的时间间隔较短可改善儿科过敏分类。·及时进行过敏咨询至关重要，且检查有助于确认或排除儿童过敏。
