Retrospective Examınatıon of Children with Beta Lactam-Drug Allergy: A Single-Center Experience

Öz

Objective: The occurrence of drug reactions due to IgE or T-cell-mediated hypersensitivity reactions is referred to as drug allergy. Beta-lactam antibiotic (BLA) is the most common cause of drug allergy. In our study, we aimed to determine the true frequency of allergy in patients who presented to the children’s immunology and allergy polyclinic on suspicion of BLA allergy and performed drug provocation test (DPT) and to evaluate the clinical, demographic, and laboratory characteristics of these patients. Methods: Between 2017 and 2023, 141 patients (75 immediate reaction and 66 non immediate reaction) aged 0-18 years who applied to our hospital’s pediatric immunology and allergy outpatient clinic with suspicion of BLA allergy and underwent DPT were included. Retrospective records from the last 6 years were examined from hospital data; age (month), sex, history of concomitant chronic diseases, history of additional allergic diseases, history of drug allergies in the family, type of reaction, serum total IgE, percentage of eosinophils (%), history of BLA use (penicillin V, penicillin G, ampicillin, amoxicillin etc.), specific IgE values, and drug intradermal test (IDT) results were recorded. Results: In our study, 141 patients aged between 0 and 18 years were evaluated. 33 (23.4%) of them were IDT-positive. DPT was not performed because 24 patients did not have family permission and 9 patients experienced anaphylaxis. In our study, the BLA allergy rate determined by and/or skin tests was 26.9%, whereas the frequency of BLA allergy confirmed by DPT was 5.6%. Conclusions: Beta lactam antibiotics are widely used worldwide and are the most common cause of drug-induced allergic reactions. Diagnosing a drug allergy thought to be associated with BLA based on history alone leads to the unnecessary use of broad-spectrum antibiotics and, consequently, to the development of antibiotic resistance. The patients should be referred to the child allergy department to be able to be definitively diagnosed for patients with suspected BLA drug allergy. Thus, we hope that unnecessary broad-spectrum antibiotics will be prescribed and that the use of expensive drugs will be prevented.

Anahtar Kelimeler

• Child
• drug allergy
• beta-lactam
• penicillin
• cephalosporin

Kaynakça

1. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011;127(3):587-93. google scholar
2. Arga M, Topal E. Anaphylaxis in children: what is it? What is it not? Clin Med Pediatr. 2020;12(2):103-13. google scholar
3. Civelek E. Food allergy. Turk J Pediatr. 2020;14(3):199-199. google scholar
4. Borch JE, Andersen KE, Bindslev-Jensen C. Prevalence of suspected and challenge-verified penicillin allergy in a university hospital population. Basic Clin Pharmacol Toxicol. 2006;98(4):357-62. google scholar
5. Erkoçoğlu M, Mısırlıoğlu ED, Kocabaş CN. Diagnostic evaluation of drug allergy. Turk J Pediatr. 2015;9(1):66-70. google scholar
6. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs: an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702-12. google scholar
7. Dykewicz MS, Lam JK. Drug hypersensitivity reactions. Med Clin North Am. 2020;104:109-28. google scholar
8. Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med. 2003;139:683-93. google scholar

9. Ertuğrul A, Başkaya N, Esenboğa S, Özmen S. Suspected beta-lactam antibiotic hypersensitivity in children: experiences in a pediatric allergy clinic. Guncel Pediatri. 2021;19(1):1-8. google scholar
10. Sullivan JR, Shear NH. Drug hypersensitivity syndrome: what is the pathogenesis? Arch Dermatol. 2001;137(3):357-64. google scholar
11. Köse S, Tezcan D, Işik SA, Asilsoy S, Uzuner N, Anal Ö. Evaluation of children with suspected beta-lactam allergy: a retrospective study. Turk J Pediatr. 2017;11:40-5. google scholar
12. Tugcu GD, Cavkaytar O, Sekerel BE, Sackesen CA, Kalayci O, Tuncer A et al. Actual drug allergy during childhood: Five years of experience at a tertiary referral center. Allergol Immunopathol. 2015;43(6):571-8. google scholar
13. Sipahi Cimen S, Hizli Demirkale Z, Yucel E, Ozceker D, Suleyman A, Sayili U, Tamay Z, Guler N. Risk factors for challenge-proven beta-lactam allergy in children with immediate and non-immediate mild cutaneous reactions. Int Arch Allergy Immunol. 2023;184(6):539-49. google scholar
14. Aykan E. Retrospective examination of drug allergies encountered in children [Thesis]. Ankara: University of Health Sciences, Dr. Sami Ulus Women and Children’s Health Education and Research Hospital; 2017. google scholar
15. Caubet JC, Kaiser L, Lemaître B, Fellay B, Gervaix A, Eigenmann PA. The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol. 2011;127(1):218-22. google scholar
16. Orhan F, Karakas T, Cakir M, Akkol N, Bahat E, Sonmez FM, et al. Parental-reported drug allergy in 6-to-9-year-old urban schoolchildren. Pediatr Allergy Immunol. 2008;19(1):82-5. google scholar
17. Özhan AK, Doğruel D, Altıntaş DU, Yılmaz M. Five-year experience of early-type drug reactions at Çukurova University Pediatric Allergy Clinic. Ege Tıp Dergisi. 2018;57(3):136-41. google scholar
18. Dilber, D.H., Ozceker, D., Terzi, O. Drug allergy in children: what is the actual frequency of drug allergies? Sisli Etfal Hastan Tip Bul. 2022;56(4):552-8. google scholar
19. Akkelle E. Retrospective evaluation of skin and drug provocation test results in patients with drug reactions [Thesis]. Edirne: Trakya University Faculty of Medicine, Department of Pediatrics; 2013. google scholar
20. Özmen S, Şahin M, Yöney A, Nilüfer AR, Arslan Z. Drug-related rashes in children: a single-center experience. Turk Pediatri Arşivi. 2011;46(1):3-7. google scholar
21. J. Le, T. Nguyen, A. V. Law, J. Hodding. Adverse drug reactions among children over a ten-year period. Pediatrics. 2006;118(2):555-62. google scholar
22. Temple ME, Robinson RF, Miller JC, Hayes JR, Nahata MC. Frequency and preventability of adverse drug reactions in pediatric patients. Drug Safety. 2004;27:819-29. google scholar
23. Lüleyap D. Retrospective evaluation of data from patients admitted for drug reactions [Thesis]. İzmir: Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology; 2019. google scholar
24. Akkelle E. Retrospective evaluation of skin and drug provocation test results in patients with drug reactions [Thesis]. Edirne: Trakya University Faculty of Medicine, Department of Pediatrics; 2013. google scholar
25. Zambonino MA, Torres MJ, Munoz C, Requena G, Mayorga C, Posadas T et al. Drug provocation tests for diagnosing hypersensitivity reactions to nonsteroidal anti-inflammatory drugs in children. Pediatr Allergy Immunol. 2013;24:151-9. google scholar
26. Orhan F, Civelek E, Şahiner ÜM, Arga M, Can D, Çalıkaner AZ, et al. Anaphylaxis: Turkish National Guideline 2018. Asthma Allergy Immunol. 2018;16. google scholar
27. Macy E, Schatz M, Lin CK, KY. The decreasing rate of positive penicillin skin tests from 1995 to 2007. Perm J. 2009;13(2):12. google scholar
28. Caubet JC, Kaiser L, Lemaître B, Fellay B, Gervaix A, Eigenmann PA. The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol. 2011;127(1):218-22. google scholar
29. Cavkaytar O. Evaluation of common-allergic drug reactions in childhood [Thesis]. Ankara: Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Immunology and Allergy; 2013. google scholar