Çocukluk Çağında Sık Görülen Allerjik İlaç Reaksiyonlarının Değerlendirilmesi

Abstract

Allergic drug reactions are common problems in pediatric practice which result in significant morbidity and mortality rates. The aim of this study is to determine the rates of actual beta-lactam and nonsteroidal antiinflammatory drug (NSAID) allergy in patients with suspected allergic reaction history and to identify the demographic characteristics of patients and to establish the risk factors for drug allergy. Patients who admitted to Hacettepe University Department of Pediatric Allergy between December 2011 and April 2013 participated in the study. A questionnaire prepared by European Network of Drug Allergy (ENDA) was filled in for each patient. The patients who had a suspected allergic reaction history with beta-lactam antibiotics were tested with major determinant, minor determinant, penisilin G, ampisilin and amoksisilin-klavulanic acid through prick and intradermal (ID) tests. Intradermal late reading and patch tests were performed for the patients with negative initial skin test results with a history of a non-immediate type reaction (at least 1 hour after drug uptake). Provocation tests with the culprit drug were performed for all the patients who had negative skin test results. In patients with proven NSAID allergy oral provocation tests with aspirin and other NSAID drugs in order to determine cross reactivity among them. The positive physical finding during the provocation test and/or at least a 15%decrease in FEV1 in pulmonary function test was accepted as drug allergy.Eleven (%22.4) of the 49 patients with immediate type suspected beta-lactam allergy were diagnosed as allergic, whereas 15 (%14.6) of the 103 patients with suspected nonimmediate type beta-lactam were diagnosed as allergic and 15 (27.8%) of the 54 patients with suspected NSAID allergy were diagnosed as allergic. The most common drugs responsible forthe allergic reaction was ceftriaxone in the patients with immediate type beta-lactam allergy and amoxicillin-klavulanic acid in patients with nonimmediate type beta-lactam allergy. The majority of patients in nonimmediate type beta-lactam allergy group were diagnosed through provocation tests, whereas majority of the patients with immediate type beta-lactam allergy were diagnosed through skin tests. The frequency of anaphylaxis, gastrointestinal system, cardiovascular and pulmonary system involvement and hospitalization during the reaction and systemic corticosteroid use during reaction were statistically significantly higher (p=0.013, 0.01, 0.011, 0.012, 0.027) in patients who had a immediate type beta-lactam allergy compared with the nonallergic group. Hospitalization and gastrointestinal system involvement during the reaction increased the risk for immediate type beta-lactam allergy. The frequency of atopy, angioedema during the reaction, and systemic steroid use for the treatment of the reaction were higher in patients with nonimmediate type beta-lactam allergy, whereas the frequency of upper respiratory tract infection was lower (p=0.047, 0.023, 0.026, 0.017) compared with the nonallergic ones. Angioedema was found to increase the risk in nonimmediate type beta-lactam allergy. The frequency of angioedema, single drug use and immediate type reaction (<1 hour after the drug intake) were higher in patients with NSAID allergy compared with the nonallergic ones (p=0.016, 0.011, 0.034). Single drug use during the reaction was found to increase the risk of NSAID allergy. As a result immediate type beta-lactam antibiotic and NSAID allergy in childhood were not affected by the presence of atopy or atopic diseases. Although the frequency of suspected nonimmediate type beta-lactam reaction was higher, the frequency of actual allergy was higher in patients with immediate type beta-lactam allergy. Frequent pulmonary function testing prevents serious reactions during NSAID provocation. We think that our study contributes to further classification of childhood drug allergies in order to explain the underlying pathogenesis.