Evaluation of Clinical Properties and Diagnostic Test Results of Cephalosporin Allergy in Children

2021 ◽  
pp. 1-7
Author(s):  
Ozge Yilmaz Topal ◽  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Diagnostic Test ◽  
Pediatric Patients ◽  
Drug Hypersensitivity ◽  
Maculopapular Rash ◽  
Test Results ◽  
Pediatric Allergy ◽  
Fixed Drug ◽  
Drug Hypersensitivity Reactions ◽  
Immediate Reactions

Introduction: Beta-lactams (BLs) are one of the most frequent causes of drug hypersensitivity reactions (HRs), and cephalosporins are a widely used subclass of BLs, especially in children. The aim of this study was to evaluate the clinical features and diagnostic test results of pediatric patients evaluated for suspected cephalosporin allergy. Methods: This study included patients who presented to our pediatric allergy clinic with a history of reactions attributed to cephalosporins between January 1, 2011, and December 31, 2019, and whose diagnostic tests were completed for the diagnosis. Results: This study included 120 pediatric patients and 69 (57.5%) of them were girls. The median age was 38.63 (interquartile range 10.5–85.7) months. Reactions occurring within 1 h of drug intake were reported in 33 patients (27.5%). Reactions were maculopapular rash in 55 (45.8%) patients, urticaria and/or angioedema in 49 (40.8%), anaphylaxis in 11 (9.2%), severe cutaneous drug reaction in 4 (3.3%), and fixed drug reaction in 1 patient (0.83%). The most frequently suspected agent was cefixime in 41 patients (34.2%). In total, 30 (25%) patients were diagnosed as having cephalosporin hypersensitivity. Confirmation of HRs was also significantly more frequent among patients who were older (p: 0.000), who had taken the drug parenterally (p: 0.000) and with immediate reactions (p: 0.000). Conclusion: Cephalosporin allergy has been confirmed in approximately one-fourth of the patients evaluated for suspected cephalosporin allergy. Confirmation of HRs was significantly more common among patients who were older, had immediate reactions, and had taken the drug parenterally.

scholarly journals Converter Phenotype: A New Profile That Is Not Exclusive to Taxanes

2022 ◽  
Vol 2 ◽  
Author(s):  
Teodorikez Wilfox Jimenez-Rodriguez ◽  
Francisco Manuel Marco de la Calle ◽  
Inmaculada Lozano-Cubo ◽  
Rosa Ana Montoyo-Anton ◽  
Victor Soriano-Gomis ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Drug Exposure ◽  
Drug Hypersensitivity ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Test Results ◽  
Drug Reactions ◽  
Immediate Hypersensitivity ◽  
Drug Hypersensitivity Reactions ◽  
Median Interval

Introduction: Phenotype I hypersensitivity reactions are the most commonly reported drug reactions; however, precision medicine has made it possible to characterize new phenotypes. A recent communication proposed the existence of a “converter phenotype,” which would affect patients who present non-immediate hypersensitivity reactions and in subsequent exposures develop immediate hypersensitivity reactions. This study aimed to describe the clinical characteristics of converter phenotype reactions and their evolution during desensitization to chemotherapeutic drugs and monoclonal antibodies.Methods: We retrospectively reviewed our database of patients undergoing desensitization to chemotherapy or biological agents and selected those with a converter phenotype. Demographic and clinical characteristics of the patients, the results of skin tests, tryptase and IL-6 levels, and desensitization outcomes were assessed.Results: Of 116 patients evaluated, 12 (10.3%) were identified as having a converter phenotype. The median interval between drug exposure and reaction was 90.6 h (range 8-288 h). After the conversion, phenotype I was the most frequent (58.3%), followed by cytokine release reactions (33.3%). Fifty-one desensitizations were undertaken and all treatments completed, with 10 (19.6%) breakthrough reactions. No new changes in the phenotype were detected.Conclusions: The symptoms of non-immediate drug hypersensitivity reactions may indicate the need for an early allergological evaluation to assess the risk of future immediate drug reactions. Clinical characteristics, skin test results, and biomarkers can help predict responses to rapid drug desensitization, guiding clinicians on how to optimize therapy delivery while maintaining patient safety.

scholarly journals Evaluation of drug patch tests in children

2021 ◽  
Vol 42 (2) ◽  
pp. 167-174
Author(s):  
Şule Büyük Yaytokgil ◽  
Hakan Güvenir ◽  
İlknur Külhaş Celík ◽  
Özge Yilmaz Topal ◽  
Betül Karaatmaca ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Patch Test ◽  
Antiepileptic Drugs ◽  
Adverse Reactions ◽  
Drug Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Test Results ◽  
Fixed Drug Eruption ◽  
Patch Tests ◽  
Drug Patch Tests

Background: Patch tests are used to diagnose nonimmediate T-cell‐mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Methods: Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. Results: A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4‐11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. Conclusion: In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.

A Novel Desensitization Protocol for Infliximab Hypersensitivity in a 13-Year Old Patient with Pustular Psoriasis

2019 ◽  
Vol 14 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Sapan Kumar Behera ◽  
Sandhiya Selvarajan ◽  
Jerene Mathews ◽  
Chandana Shajil ◽  
Saibal Das ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Drug Hypersensitivity ◽  
Pediatric Intensive Care ◽  
Pustular Psoriasis ◽  
Drug Hypersensitivity Reactions ◽  
Desensitization Protocol ◽  
Larger Sample

Background: Drug hypersensitivity reactions to infliximab have been reported in pediatric patients. At times, these patients may need infliximab administration in spite of hypersensitivity. However, only a few reports of desensitization protocols are available in the literature in pediatric patients. Case Report:We report a case of immediate hypersensitivity reaction to intravenous infliximab in a 13-year-old child suffering from pustular psoriasis who eventually underwent a 14 step desensitization protocol for the administration of infliximab in a pediatric intensive care unit. Results and Conclusion:Although our desensitization protocol was safe and effective, we recommend the entire desensitization procedure to be performed under the supervision of experienced personnel in a pediatric intensive care unit. Future studies with larger sample size are needed to confirm our findings.

scholarly journals Evaluation of the Drug Hypersensitivity Reactions Prevalence in Hospitalized Children in Sari City from 2014 to 2018: An Original Research

2021 ◽  
Vol 9 (3) ◽  
pp. 229-238
Author(s):  
Hamidreza Houshmand ◽  
◽  
Mohammad Reza Shiran ◽  
Javad Ghaffari ◽  
Mahdi Abounoori ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Urban Areas ◽  
Drug Allergy ◽  
Drug Hypersensitivity ◽  
Original Research ◽  
Hospitalized Children ◽  
Hypersensitivity Reactions ◽  
The North ◽  
Drug Hypersensitivity Reactions ◽  
North Of Iran

Background: Drug allergy is a subtype of Adverse Drug Reaction (ADR) mediated by the immunologic system. Extreme drug allergy is poorly known in children that contribute to hospitalization in our region. Objectives: This research aimed to study major drug hypersensitivity reactions in the north of Iran among the hospitalized children. Methods: This cross-sectional study was conducted at Bou Ali Sina Hospital in the north of Iran. We analyzed the medical files of 140 children admitted to the hospital with drug allergies from 2014 to 2018. The inclusion criteria were based on the DRESS (drug reaction with eosinophilia and systemic symptoms) scoring system, and those who scored more than four were enrolled. Patients with incomplete medical charts were excluded. The sampling methodology was based on the consecutive census method. Results: In the current study, 62 patients were females (44.29%), and 78 were males (55.71%). Ninety-six cases (68.57%) were children under five, and 44 cases (31.43%) were over five years old. Most ADRs were seen in patients from urban areas (58.57%) than in rural areas (41.43%). In 116 children (82.6%), maculopapular rashes were seen. Phenobarbital and cefalexin had the highest levels of drug reactions, including 85 persons (55.19%) and 18 persons (11.69%), respectively. Pruritus, fever, and scaling were the most common symptoms observed in the patients. The most commonly used treatment was antihistamines. Conclusions: The most causative medication inducing ADR was phenobarbital. The maculopapular rash was the most common skin manifestation, and there were no relationships between sex, age, medication type, and type of hypersensitivity reactions.

scholarly journals Viral Infections and Cutaneous Drug-Related Eruptions

2021 ◽  
Vol 11 ◽  
Author(s):  
Eleonora Anci ◽  
Camille Braun ◽  
Annalisa Marinosci ◽  
Frédérique Rodieux ◽  
Elise Midun ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Viral Infections ◽  
Current Knowledge ◽  
Drug Hypersensitivity ◽  
Acute Infection ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Drug Induced ◽  
Barr Virus ◽  
Systemic Symptoms

In the general population, up to 10% of children treated by antibiotics have cutaneous adverse drug reaction, but allergy is confirmed in less than 20% of patients. Most of the non-allergic reactions are probably due to virus, such as enterovirus acute infection or Ebstein-Barr Virus (EBV) acute infection or reactivation. Especially in children, viruses have the propensity to induce skin lesions (maculopapular rash, urticaria) due to their skin infiltration or immunologic response. In drug-related skin eruptions, a virus can participate by activating an immune predisposition. The culprit antibiotic is then the trigger for reacting. Even in severe drug-induced reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, viruses take part in immune phenomena, especially herpes viruses. Understanding the mechanisms of both virus- and drug-induced skin reaction is important to develop our clinical reflection and give an adaptive care to the patient. Our aim is to review current knowledge on the different aspects and potential roles of viruses in the different type of drug hypersensitivity reactions (DHR). Although major advances have been made those past year, further studies are needed for a better understanding of the link between viruses and DHR, to improve management of those patients.

A case of an acute cutaneous drug reaction with hydroxychloroquine

2018 ◽  
Vol 63 (3) ◽  
pp. 91-94 ◽  
Author(s):  
Amritakaur Randhawa ◽  
Grant Wylie
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Drug Hypersensitivity ◽  
Topical Steroids ◽  
Cutaneous Side Effects ◽  
Culprit Drug ◽  
Drug Hypersensitivity Reactions ◽  
Reaction Potential ◽  
Cutaneous Adverse Drug Reaction ◽  
Cutaneous Drug Reaction

Hydroxychloroquine is considered a relatively benign drug and is regularly used by rheumatologists and dermatologists. We highlight the severe adverse drug reaction potential of this commonly prescribed medication. We report the case of a 63-year-old male, who presented with widespread skin eruption following initiation of hydroxychloroquine two weeks earlier for an inflammatory arthritis. He had typical clinical, biochemical and histological features of the now recognised formal ‘diagnosis’ of severe cutaneous adverse drug reaction. The culprit drug was stopped and he responded to oral and topical steroids as well as supportive measures. Severe reactions to hydroxychloroquine are uncommon; however, as in this case, drug hypersensitivity reactions often manifest in skin. In a drug normally considered to be safe, these potential cutaneous side effects should be highlighted in information given to patients prior to commencement.

Skin testing and drug challenge in the evaluation of drug hypersensitivity reactions

2021 ◽  
Vol 42 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Anna R. Wolfson ◽  
Aleena Banerji
Keyword(s):  
Negative Impact ◽  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Clinical History ◽  
Hypersensitivity Reactions ◽  
Causative Drug ◽  
Care Assessment ◽  
Drug Hypersensitivity Reactions ◽  
Drug Challenge ◽  
Drug Challenges

Immediate hypersensitivity to drugs is characterized by symptoms such as hives, swelling, and wheezing. To prevent a negative impact on care, assessment by an allergist is important. Evaluation requires a clear clinical history, but it is often lacking or vague, which makes a diagnosis difficult. Allergists instead can use skin testing and drug challenge to evaluate drug hypersensitivity reactions, which help the patient and provider understand the causative drug(s) and, more importantly, enables the use of the exonerated drug(s). Although penicillin skin testing is standardized, well described, and widely used, skin testing for most other drugs requires the use of a nonirritating skin testing concentration that can have a low negative predictive value. Drug challenges are the criterion standard for confirming tolerance. The allergist must obtain an in-depth clinical history and then follow with skin testing and/or drug challenges when indicated to determine which drugs can be de-labelled and which should be avoided. In this review, we focused on the evaluation of drug hypersensitivity reactions to antibiotics, perioperative agents, biologics, and chemotherapeutics.

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