Çocuklardaki İlaç Aşırı Duyarlılık Reaksiyonlarının Özellikleri: Alerji Polikliniğinde Retrospektif Analiz

Yıl 2024, , 247 - 252, 22.07.2024

Şule Büyük Yaytokgil , Emine Vezir

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

Öz

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.

Anahtar Kelimeler

antibiyotik alerjisi, ilaç alerjisi, ilaç aşırı duyarlılık reaksiyonları

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

Öz

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.

Anahtar Kelimeler

antibiotic allergy, drug allergy, drug hypersensitivity reactions

Kaynakça

• Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF,et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J AllergyClin Immunol 2004;113:832-6.
• Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al; ENDA/EAACI DrugAllergy Interest Group. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016;71:149-61.
• Gomes ER, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: from self-reporting to confirmed diagnosis. Clin Exp Allergy 2008;38:191-8.
• Seitz CS, Bröcker EB, Trautmann A. Diagnosis of drug hypersensitivity in children and adolescents: discrepancy between physician-based assessment and results of testing. Pediatr Allergy Immunol 2011; 22:405-10.
• Erkoçoğlu M, Kaya A, Civelek E, Ozcan C, Cakır B, Akan A, et al. Prevalence of confirmed immediate type drug hypersensitivity reactions among school children. Pediatr Allergy Immunol 2013 ;24:160-7.
• Waheed A, Hill T, Dhawan N. Drug Allergy. Prim Care 2016;43:393-400.
• Demoly P, Adkinson NF, Brockow K,Castells M, Chiriac AM, Greenberger PA, etal. International Consensus on drug allergy. Allergy 2014;69:420-37.
• Dibek Misirlioglu E, Guvenir H, Ozkaya Parlakay A, Toyran M, Tezer H, Catak AI, et al. Incidence of Antibiotic-Related Rash in Children with Epstein-Barr Virus Infection and Evaluation of the Frequency of Confirmed Antibiotic Hypersensitivity. Int Arch Allergy Immunol 2018;176:33-8.
• Mori F, Liccioli G, Tomei L, Barni S, Giovannini M, Sarti L, et al. How to manage drug-virus interplay underlying skin eruptions in children. World Allergy Organ J 2024;17:100877.
• Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. EAACI Task Force on Anaphylaxis in Children. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy 2007; 62:857-71.
• Dykewicz MS, Lam JK. Drug hypersensitivity reactions. Med Clin N 2020;104:109-28.
• Çelik G, Dursun BA. Approach to Drug Hypersensitivity Reactions: National Guidelines Update 2019. Turkish National Society of Allergy and Clinical Immunology Ankara 2019.
• 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: 702-12.
• Aberer W, Bircher A, Romano A,Blanca M, Campi P, Fernandez J, et al. European Network for Drug Allergy (ENDA); EAACI interest group on drug hypersensitivity reactions:general consideration. Allergy 2003;58:854-63.
• Capanoglu M, Erkocoglu M, Kaya A, Dibek Misirlioglu E, Ginis T, Toyran M, et al. Confirmation of drug allergy in a general pediatrics outpatient clinic. Ann Allergy Asthma Immunol 2022;129:784-89.
• Milosevic K, Malinic M, Plavec D, Lekovic Z, Lekovic A, Cobeljic M, et al. Diagnosing Single and Multiple Drug Hypersensitivity in Children: A Tertiary Care Center Retrospective Study. Children (Basel) 2022;9:1954.
• Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunoll 2005; 5:309-16.
• Shiohara T, Kano Y. A complex interaction between Drug allergy and viral infection. Clin Rev Allerg Immunol 2007;33:124-33.
• Bergmann M, Caubet JC. Specific Aspects of Drug Hypersensitivity in Children. Curr Pharm Des 2016;22:6832-51