Risk Factors for Drug Allergies in Pediatric Palliative Care Patients

Abstract

Background / aim: Children receiving pediatric palliative care constitute a medically fragile population. Despite this vulnerable clinical profile, data on drug allergy in pediatric palliative care remain scarce. This study aimed to determine the frequency, clinical characteristics, and associated factors of clinically defined drug allergy in children hospitalized in a tertiary pediatric palliative care center. Methods: This retrospective observational study included all children hospitalized in a tertiary pediatric palliative care center. Drug allergy was clinically defined according to predefined diagnostic criteria, and in vivo and/or in vitro allergy work-up was performed in selected patients. Demographic and clinical characteristics, hospitalization-related variables, and medication burden were compared between patients with and without drug allergy. Results: A total of 281 hospitalized children were included. Clinically defined drug allergy was identified in 26 patients (9.2%). Antimicrobials were the most frequently implicated drug group (57.7%), followed by antiepileptic drugs (11.5%) and non-steroidal anti-inflammatory drugs (7.7%). Most reactions were immediate (21/26), whereas 5 were non-immediate. One patient developed ranitidine-associated anaphylaxis, and one developed oxybutynin-associated DRESS. In multivariate analysis, older age (OR 1.168; 95% CI 1.036-1.316; p=0.011), longer hospital stay (OR 1.032; 95% CI 1.014-1.050; p<0.001), and a higher number of medications (OR 1.656; 95% CI 1.254-2.189; p<0.001) remained independently associated with drug allergy. Conclusions: Clinically defined drug allergy was not uncommon among hospitalized children receiving pediatric palliative care. Antimicrobials were the leading culprit drugs, while antiepileptic drugs also represented a notable contributor, likely reflecting the high neurological disease burden of this population. Greater medication exposure and prolonged hospitalization were the strongest correlates of drug allergy.

Keywords

• Pediatrics
• Palliative Care
• Drug Hypersensitivity
• Drug Allergy
• Polypharmacy

Ethical Statement

The study included pediatric patients hospitalized between November 2018 and March 2022. The study protocol was approved by İzmir Dr. Behçet Uz Children’s Diseases and Surgery Training and Research Hospital Hospital institutional local ethics committee (Approval date: 11.08.2022, approval number: GOA-722).

Çocuk Palyatif Bakım Hastalarında ilaç Alerjileri için risk faktörleri

Abstract

Amaç: Pediatrik palyatif bakım alan çocuklar; tıbbi açıdan hassas bir popülasyonu oluşturmaktadır. Bu hassas profile rağmen, pediatrik palyatif bakımda ilaç alerjisine ilişkin veriler sınırlıdır. Bu çalışmanın amacı, üçüncü basamak pediatrik palyatif bakım merkezine yatırılan çocuklarda klinik olarak tanımlanmış ilaç alerjisinin sıklığını, klinik özelliklerini ve ilişkili risk faktörlerini belirlemektir. Yöntemler: Bu retrospektif gözlemsel çalışmaya, üçüncü basamak pediatrik palyatif bakım merkezine yatırılan tüm çocuklar dahil edildi. İlaç alerjisi, önceden tanımlanmış tanısal kriterlere göre klinik olarak tanımlandı ve seçilmiş hastalarda in vivo ve/veya in vitro alerjik değerlendirme yapıldı. İlaç alerjisi olan ve olmayan hastalar arasında demografik ve klinik özellikler, hastaneye yatışla ilişkili değişkenler ve ilaç yükü karşılaştırıldı. Bulgular: Toplam 281 çocuk çalışmaya dahil edildi. Klinik olarak tanımlanmış ilaç alerjisi 26 hastada (%9,2) saptandı. En sık suçlanan ilaç grubu antimikrobiyallerdi (%57,7); bunu antiepileptik ilaçlar (%11,5) ve nonsteroid antiinflamatuvar ilaçlar (%7,7) izledi. Reaksiyonların çoğu erken tipteydi (21/26), 5’i ise geç tipteydi. Bir hastada ranitidin ile ilişkili anafilaksi, bir hastada ise oksibutinin ile ilişkili DRESS gelişti. Çok değişkenli analizde ileri yaş (OR 1,168; %95 GA 1,036-1,316; p=0,011), daha uzun hastanede kalış süresi (OR 1,032; %95 GA 1,014-1,050; p<0,001) ve daha fazla sayıda ilaç kullanımı (OR 1,656; %95 GA 1,254-2,189; p<0,001) ilaç alerjisi ile bağımsız olarak ilişkili bulundu. Sonuç: Pediatrik palyatif bakım hastalarında klinik olarak tanımlanmış ilaç alerjisi nadir değildir. Antimikrobiyaller en sık suçlanan ilaç grubu iken, antiepileptik ilaçlar da bu popülasyondaki yüksek nörolojik hastalık yükünü yansıtır biçimde dikkate değer bir katkı sağlamıştır. Daha fazla ilaç maruziyeti ve uzun süreli hastanede kalış, ilaç alerjisiyle en güçlü ilişkili faktörler olmuştur.

Keywords

• Pediatri
• Palyatif Bakım
• İlaç Aşırı Duyarlılığı
• İlaç Alerjisi
• Çoklu İlaç Kullanımı

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