Retrospective Evaluation of Patients Undergoing Drug Provocation Tests

Öz

Objective: This study aims to evaluate the demographic characteristics of patients presenting with suspected drug allergies, identify the implicated drugs, classify the types of reactions observed, and assess the contribution of drug provocation tests in diagnosis. Methods: A total of 47 patients who underwent drug provocation tests between January 2023 and December 2024 were retrospectively analyzed. Data on age, gender, suspected drugs, symptoms, onset time, and comorbidities were collected. Provocation tests were conducted in a controlled hospital setting, and necessary medical interventions were performed for positive reactions. Results: Of the patients, 59.57% were female and 40.43% were male, with a mean age of 111.68 months. Antibiotics (61.70%) and NSAIDs (Non-Steroidal Anti-inflammatory Drugs) (23.40%) were the most implicated drug groups. Beta-lactam antibiotics were identified as the leading drug group. Among reactions, maculopapular rash (31.48%) and angioedema (27.78%) were the most common symptoms. Early reactions (48.33%) were observed more frequently, while delayed reactions accounted for 41.67%. Conclusion: Drug provocation tests are reliable tools for evaluating low-risk drug allergy probabilities and preventing unnecessary labeling of allergies. This study provides valuable insights into the management and treatment of drug allergies in children.

Anahtar Kelimeler

• Drug hypersensitivity
• drug provocation test
• maculopapular rash
• Urticaria

Kaynakça

1. 1. Gelincik A, Özşeker ZF, Çolakoğlu B, Dal M, Büyüköztürk S. Antibiyotiklere bağlı hipersensitivite reaksiyonları: Alternatif antibiyotik saptanmasında provakasyon testlerinin önemi. Asthma Allergy Immunol 2013; 11(1): 23-31.
2. 2. Warrington, Richard, Fanny Silviu-Dan, and Tiffany Wong. "Drug allergy." Allergy, Asthma & Clinical Immunology 14 (2018): 1-11.
3. 3. Mill C, Primeau M-N, Medoff E, et al. Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatr 2016; 170: e160033.
4. 4. Penicillin allergy FAQ. Milwaukee: American Academy of Allergy, Asthma & Immunology; reviewed 2020 Sept. 28. Available: www.aaaai.org/conditions-and- treatments/library/allergy-library/penicillin-allergy-faq (accessed 2019 Nov. 21).
5. 5. Turner NA, Moehring R, Sarubbi C, et al. Influence of reported penicillin allergy on mortality in MSSA bacteremia. In: Open forum infectious diseases. US: Oxford University Press, 2018. p. ofy042.
6. 6. Mattingly TJ II, Fulton A, Lumish RA, et al. The cost of self-reported penicillin allergy: a systematic review. J Allergy Clin Immunol Pract 2018; 6: 1649-54.e4.
7. 7. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014; 133: 790-6.
8. 8. MacFadden DR, LaDelfa A, Leen J, et al. Impact of reported beta-lactam allergy on inpatient outcomes: a multicenter prospective cohort study. Clin Infect Dis 2016; 63: 904-10.

9. 9. Aberer W, Bircher A, Romano A, et al. "Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations." Allergy 58.9 (2003): 854-63.
10. 10. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: An updated practice parameter. Ann. Allergy Asthma Immunol. 2010, 105, 259–73.
11. 11. Muraro A, Lemanske RF, Castells M, et al. "Precision medicine in allergic disease—food allergy, drug allergy, and anaphylaxis—PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology." Allergy 72.7 (2017): 1006-21.
12. 12. Demoly P. Anaphylactic reactions—Value of skin and provocation tests. Toxicology 2005, 209, 221–3.
13. 13. Chiriac Anca Mirela, and Pascal Demoly. "Drug provocation tests: up-date and novel approaches." Allergy, Asthma & Clinical Immunology 9 (2013): 1-5.
14. 14. Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014, 69, 420–37.
15. 15. Shenoy ES, Macy E, Rowe T, et al. Evaluation and management of penicillin allergy: a review. JAMA 2019; 321: 188-99.
16. 16. Gonzalez-Estrada A, Radojicic C. Penicillin allergy: a practical guide for clinicians. Cleve Clin J Med 2015; 82: 295-300.
17. 17. Türkiye Ulusal Allerji ve Klinik İmmünoloji Derneği. I􀇚laç aşırı duyarlılık reaksiyonlarına yaklaşım: Ulusal Rehber Güncellemesi. Ankara, 2019.
18. 18. Kont Özhan A, Doğruel D, Ufuk Altıntaş D, Yılmaz M. Erken tip ilaç reaksiyonlarında beş yıllık Çukurova Üniversitesi Çocuk Alerji Kliniği deneyimi. EJM. 2018; 57(3): 136-41.
19. 19. Aydoğdu A, Akçam NY. Retrospective evaluation of children with non-steroidal anti-inflammatory drug allergy. Journal of Cukurova Anesthesia and Surgical Sciences, 2023; 6(2), 215-9.
20. 20. Smyth RMD, Gargon E, Kirkham J, et al. Adverse drug reactions in children-A systematic review. PLoS One 2012; 7(3): e24061.
21. 21. Tugcu GD, Cavkaytar O, Sekerel BE, et al. Actual drug allergy during childhood: Five years' experience at a tertiary referral centre. Allergologia et immunopathologia, 2015; 43(6), 571–8.
22. 22. Caubet JC, Kaiser L, Lemaitre B, et al. The role of penicillin in benign skin rashes in childhood: A prospective study based on drug rechallenge. J. Allergy Clin. Immunol. 2011, 127, 218–22.