Çocuklardaki İlaç Aşırı Duyarlılık Reaksiyonlarının Özellikleri: Alerji Polikliniğinde Retrospektif Analiz

Year 2024, Volume: 18 Issue: 4, 247 - 252, 22.07.2024

Şule Büyük Yaytokgil Emine Vezir

https://doi.org/10.12956/tchd.1462063

Abstract

Amaç: Çocuklardaki viral enfeksiyonlar gibi alerjik olmayan çeşitli reaksiyonlar ilaç hipersensitivite reaksiyonları (İHR)’yi taklit edebildiğinden, ilaca aşırı duyarlılık reaksiyonlarının (İADR) doğrulanması çok önemlidir. Bu çalışma, alerji polikliniğine İADR şüphesi ile başvuran çocukların özelliklerini değerlendirmeyi amaçlamaktadır.

Gereç ve Yöntemler: Çalışmaya 1 Nisan 2023-31 Aralık 2023 tarihleri arasında hastanemiz çocuk alerji kliniği’ne İADR şüphesi ile başvuran çocuk hastalar dahil edildi. Hasta verileri retrospektif olarak analiz edildi. Hastanın demografik verileri, reaksiyon özellikleri, şüpheli ilaçlar, uygulanan tanısal testler (deri ve/veya provokasyon testleri) ve reaksiyonların nihai tanıları kaydedildi.

Bulgular: Çalışmaya 140 hastanın 176 süpheli ilaç ile olan 163 reaksiyonu dahil edildi. Ortanca yaşları 7.7 yaş (Çeyrekler Arası Aralık [ÇAA]; 5.1-12) ve cinsiyet dağılımı eşitti. Hastaların %27.1’inde eşlik eden diğer atopik hastalık mevcuttu. Reaksiyon ortaya çıkış yaş ortancası 72 ay (ÇAA; 34.5-108 ay)’dı. Reaksiyonların %16’sı hastanede, %84’ü hastane dışında gelişirken; ilaçların % 84.7’si oral yolla alınmıştı. En sık sorumlu ajanlar antibiyotiklerdi (%75.5).Reaksiyonların %41.1’i (n=67) erken, %58.9’u (n= 96) ise geç tip reaksiyondu. En sık cilt semptomu (%97.5) görüldü. Reaksiyonların %75.5’inde (n=123) İHR ekarte edildi; %4.9’unda (n=8) ilaç alerjisi tanısal testler ile doğrulandı.

Sonuç: Çocuklarda şüpheli İADR’nin ayrıntılı bir şekilde değerlendirilmesi önemlidir. Yüksek şüphe oranlarına rağmen tanı testleri ile doğrulama oranı düşüktü; bu da doğru yönetim için uzman kliniklere yönlendirmenin ve doğrulanmış tanıların gerekliliğini vurgulamaktadır.

Keywords

antibiyotik alerjisi, ilaç alerjisi, ilaç aşırı duyarlılık reaksiyonları

Characteristics of Drug Hypersensitivity Reactions in Children: A Retrospective Analysis in an Allergy Outpatient Clinic

Abstract

Objective: Confirmation of drug hypersensitivity reactions (DHRs) is crucial—as various nonallergic reactions, such as viral infections, in children can mimic such reactions. This study aimed to evaluate the characteristics of children with suspected DHRs applying to an allergy outpatient clinic.

Material and Methods: This study involved children who visited our hospital’s pediatric allergy outpatient clinic between April 1 and December 31, 2023, with suspected DHRs . The data of patients analyzed retrospectively. Patient demographics, reaction characteristics, culprit drugs, diagnostic procedures (including skin and/or provocation tests), and final diagnoses were recorded.

Results: The study included 163 reactions of 140 patients with 176 suspected drugs. The median age was 7.7 years (interquartile range [IQR]; 5.1–12 years), with an equal gender distribution. Notably, 27.1% of the patients presented with concurrent atopic diseases. The median age at the onset of reaction was 72 months (IQR; 34.5–108 months), with 16% of reactions occurring within hospital settings and the remainder at home. Oral administration accounted for 84.7% of the reactions, with antibiotics being the most common culprit drug group (75.5%). Immediate reactions constituted 41.1% (n = 67) of reactions, while delayed reactions accounted for 58.9% (n = 96). Skin symptoms were predominant (97.5%). DHRs were excluded in 75.5% (n = 123) of reactions but confirmed by diagnostic drug allergy tests in 4.9% (n = 8).

Conclusion: A through evaluation of suspected DHRs in children is essential. Despite high suspicion rates, confirmation via diagnostic tests was low, emphasizing the need for referral to specialized clinics and appropriate diagnostics for accurate management.

Keywords

antibiotic allergy, drug allergy, drug hypersensitivity reactions

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