Metbulut Azize Pınar, Haci İdil Akay, Can Demet, Bekis Bozkurt Hayrunnisa, Cavkaytar Özlem, Arga Mustafa, Özçeker Deniz, Kavas Yildiz Yüksel, Vezir Emine, Arikoğlu Tuğba, Kuyucu Semanur, Azkur Dilek, Güvenir Hakan, Kendirci Nergiz, Orhan Fazıl, Usta Güç Belgin, Bahçeci Semiha, Dibek Misirlioğlu Emine
Pediatric Immunology and Allergy Department, Ankara Bilkent City Hospital, Ankara, Turkey.
Pediatric Immunology and Allergy Department, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
Eur J Pediatr. 2025 Mar 7;184(3):230. doi: 10.1007/s00431-025-06068-x.
The aim of the study is to elucidate demographic characteristics, risk factors, clinical presentations, causative agents, and management approaches pertaining to drug-related anaphylaxis in the paediatric population. This study is a multicenter retrospective study that included paediatric patients aged between 1 month and 18 years, who were admitted to the Pediatric Allergy and Immunology outpatient clinics of 11 participating centres with a presumptive diagnosis of drug-induced anaphylaxis, that fulfilled the standardised criteria for anaphylaxis, between January 2017 and December 2022. A total of 293 anaphylactic episodes presented among 265 patients, of which 48.1% (n 141) were female, were included. The median age of patients during the index episode was 107 months (IQR 56.5-161.5). Anaphylaxis occurred most frequently within hospital settings (62.1%, n 182) compared to home environments (34.1%, n 100). The administration were peroral in 40.3% (n 118), parenteral in 59.7% (n 175) of the cases. While antibiotics (56.7%), non-steroidal anti-inflammatory drugs (25.7%), and chemotherapeutics (3.4%) were the most commonly suspected drug groups, the cephalosporin group, and especially ceftriaxone (27.5% [n 80]) were the leading culprits among antibiotics. The anaphylaxis severity was severe in 39.6% (n 116), and moderate in 54.9% (n 161) of episodes. A biphasic reaction occurred in five patients. Only 72% (n 213) of patients were given adrenaline treatment. There were no fatalities. Diagnostic tests (n 64), including skin prick, intradermal, and drug provocation tests, which were performed between 1 and 120 months after the index reaction, yielded positive results in 23.4% (n 15), 17.2% (n 11), and 20.3% (n 13) of cases respectively, giving a total confirmation of 39 patients. Four patients underwent suspected drug desensitisation protocols. There were no fatalities.Conclusions: Antibiotics, particularly ceftriaxone, were the most commonly implicated agents in paediatric drug-induced anaphylaxis. Non-steroidal anti-inflammatory drugs, particularly ibuprofen, constituted the second most frequently implicated drug group. Paediatric patients experiencing drug-related anaphylaxis warrant algorithmic evaluation to ensure accurate diagnosis, prevent recurrence, and identify safe alternative treatments.
本研究的目的是阐明儿科人群中与药物相关过敏反应的人口统计学特征、危险因素、临床表现、致病因素及管理方法。本研究为多中心回顾性研究，纳入了2017年1月至2022年12月期间在11个参与中心的儿科过敏与免疫学门诊就诊、初步诊断为药物性过敏反应且符合过敏反应标准化标准的1个月至18岁儿科患者。共纳入265例患者出现的293次过敏反应发作，其中48.1%（n = 141）为女性。索引发作期间患者的中位年龄为107个月（IQR 56.5 - 161.5）。与家庭环境（34.1%，n = 100）相比，过敏反应在医院环境中发生最为频繁（62.1%，n = 182）。给药途径为口服的占40.3%（n = 118），注射的占59.7%（n = 175）。虽然抗生素（56.7%）、非甾体抗炎药（25.7%）和化疗药物（3.4%）是最常被怀疑的药物类别，但头孢菌素类，尤其是头孢曲松（27.5% [n = 80]）是抗生素中最主要的罪魁祸首。39.6%（n = 116）的过敏反应严重，54.9%（n = 161）为中度。5例患者出现双相反应。仅72%（n = 213）的患者接受了肾上腺素治疗。无死亡病例。在索引反应后1至120个月进行的诊断测试（n = 64），包括皮肤点刺、皮内和药物激发试验，分别在23.4%（n = 15）、17.2%（n = 11）和20.3%（n = 13）的病例中产生阳性结果，共确诊39例。4例患者接受了疑似药物脱敏方案。无死亡病例。结论：抗生素，尤其是头孢曲松，是儿科药物性过敏反应中最常涉及的药物。非甾体抗炎药，尤其是布洛芬，是第二常涉及的药物类别。经历药物相关过敏反应的儿科患者需要进行系统评估，以确保准确诊断、预防复发并确定安全的替代治疗方法。
