Clinical Presentation and Outcomes of Pediatrics Patients Undergoing Evaluation for Drug Allergy in Ramathibodi Hospital
Keywords:
drug allergy; drug provocation test; clinical presentation of drug allergyAbstract
Background and objectives: Drug allergy is a major problem frequently encountered. Patients are frequently over diagnosed as having drug allergy without proper confirmatory tests. The aims of this study were to assess prevalence, clinical presentation and outcomes among pediatric patients suspected of having a drug allergy form medical history, and undergoing drug allergy evaluation..
Methods: Medical records of pediatric patients who had undergone evaluation for drug allergy in Ramathibodi Hospital were reviewed. Patients were confirmed to have a true drug allergy by a positive skin test and/or drug provocation test.
Results: Sixty patients were evaluated for drug allergy. Onset of symptoms was highly variable (median 4.5 hours; min-max 0.08-168). Skin and mucocutaneous reactions were the most common presentations (95%) particularly angioedema and urticaria (66.7%). The most common suspected group of drugs was antibiotics (71.7%), followed anti-pyretic/anti-inflammatory (11.7%) and respiratory drugs (6.7%). Within the group of antibiotics, Beta-lactam antibiotic was the most common suspected drug causing allergy. Only sixteen out of sixty patients (26.7%) were confirmed to have a true drug allergy, 12 patients by skin test and 4 patients by drug provocation test. Drug provocation test reactions did not correlate with presenting symptoms of drug allergy. There were no significant differences in age, onset or primary symptoms of drug allergy between the confirmed true drug allergy and no drug allergy groups.
Conclusions: Drug allergy is frequently reported, but only a minority of patients have true drug allergy. There were no precise clinical predictors for drug allergy. Thus, drug provocation tests remain the gold standard for diagnosis.
References
2. Thong BY, Tan TC. Epidemiology and risk factors for drug allergy. Br J Clin Pharmacol 2011; 71: 684-700.
3. Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: from self-reporting to confirmed diagnosis. Clin Exp Allergy 2008; 38: 191-8.
4. Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 2005; 5: 309-16.
5. Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med 2003; 348: 1556-64.
6. MacLaughlin EJ, Saseen JJ, Malone DC. Costs of beta-lactam allergies: selection and costs of antibiotics for patients with a reported beta-lactam allergy. Arch Fam Med 2000; 9: 722-6.
7. Macy E. Elective penicillin skin testing and amoxicillin challenge: effect on outpatient antibiotic use, cost, and clinical outcomes. J Allergy Clin Immunol 1998; 102: 281-5.
8. Messaad D, Sahla H, Benahmed S, Godard P, Bousquet J, Demoly P. Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med 2004; 140: 1001-6.
9. Joint Task Force on Practice P, American Academy of Allergy A, Immunology, American College of Allergy A, Immunology, Joint Council of Allergy A, et al. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010; 105: 259-73.
10. Aun MV, Bisaccioni C, Garro LS, Rodrigues AT, Tanno LK, Ensina LF, et al. Outcomes and safety of drug provocation tests. Allergy Asthma Proc 2011; 32: 301-6.
11. Na HR, Lee JM, Jung JW, Lee SY. Usefulness of drug provocation tests in children with a history of adverse drug reaction. Korean J Pediatr 2011; 54: 304-9.
12. Haddi E, Charpin D, Tafforeau M, Kulling G, Lanteaume A, Kleisbauer JP, et al. Atopy and systemic reactions to drugs. Allergy 1990; 45: 236-9.
13. Fiszenson-Albala F, Auzerie V, Mahe E, Farinotti R, Durand-Stocco C, Crickx B, et al. A 6-month prospective survey of cutaneous drug reactions in a hospital setting. Br J Dermatol 2003; 149: 1018-22.
14. Hernandez-Salazar A, Rosales SP, Rangel-Frausto S, Criollo E, Archer-Dubon C, Orozco-Topete R. Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients. Arch Med Res 2006; 37: 899-902.
15. Jung JW, Kim JY, Yoon SS, Cho SH, Park SY, Kang HR. HLA-DR9 and DR14 are associated with the allopurinol-induced hypersensitivity in hematologic malignancy. Tohoku J Exp Med 2014; 233: 95-102.
