Drug Allergy in children: focus on beta-lactams and NSAIDs
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Keywords
beta-lactams, children, drug allergy, non-steroidal anti-inflammatory drugs
Abstract
Drug hypersensitivity reactions (DHRs) are adverse reactions to a drug. In children, most common drugs inducing such reactions include beta-lactams (BLs) and non-steroidal anti-inflammatory drugs (NSAIDs). The aim of the present work was to provide current knowledge on the management of DHRs in the pediatric population, focusing on BLs and NSAIDs hypersensitivity. The clinical feature of DHRs include immediate and non-immediate (delayed and accelerated) reactions, that may be severe or non-severe. A systematic approach to the patient based on the reported clinical history is essential to organize a safe and adapted allergy work-up. Skin tests are the first step to assess a possible DHRs, especially in immediate reactions to BLs. Drugs concentrations for these tests are standardized and validated. The drug provocation test remains the gold standard to reach a firm diagnosis. In selected cases, a therapeutic desensitization protocol may be proposed in children with a confirmed diagnosis of drug hypersensitivity. Clinicians should be aware of the diagnostic and therapeutic options, to provide the best management in children having experienced a history of DHR.
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References
2. Gomes ER, Brockow K, Kuyucu S, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy interest group. Allergy 2016; 71: 149-61.
3. Caffarelli C, Franceschini F, Caimmi D, et al. SIAIP position paper: provocation challenge to antibiotics and non-steroidal anti-inflammatory drugs in children. Ital J Pediatr 2018; 44: 147.
4. Diaferio L, Giovannini M, Clark E, Castagnoli R, Caimmi D. Protocols for drug allergy desensitization in children. Expert Rev Clin immunol 2020; 16: 91-100.
5. Pichler WJ. Immune pathomechanism and classification of drug hypersensitivity. Allergy 2019; 74: 1457-71.
6. Demoly P. Allergies aux médicaments. Available at: http://www.e-allergie.fr (last access May 18th, 2020).
7. Cousin M, Chiriac A, Molinari N, Demoly P, Caimmi D. Phenotypical characterization of children with hypersensitivity reactions to NSAIDs. Pediatr Allergy Immunol 2016; 27: 743-8.
8. Kidon M, Blanca-Lopez N, Gomes E, et al. EAACI/ENDA Position Paper: diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in chnildren and adolescents. Pediatr Allergy Immunol 2018; 29: 469-80.
9. Cavkaytar O, du Toit G, Caimmi D. Characteristics of NSAID-induced hypersensitivity reactions in childhood. Pediatr Allergy Immunol 2019; 30: 25-35.
10. Diaferio L, Chiriac AM, Leoni MC, et al. Skin tests are important in children with beta-lactam hypersensitivity, but may be reduced in number. Pediatr Allergy Immunol 2019; 30: 462-8.
11. 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: 218)22.
12. Romano A, Atanaskovic-Markovic M, Barbaud A, et al. Towards a more precise diagnosis of hypersensitivity to beta-lactams - An EAACI Position Paper. Allergy 2020;75:1300-1315
13. Blanca-Lopez N, Haroun-Diaz E, Ruano FJ, et al. Acetyl salicylic acid challenge in children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs differentiates between cross-intolerant and selective responders. J Allergy Clin Immunol Pract 2018; 6: 1226-35.
14. Eser Simsek I, Cogurlu MT, Aydogan M. Two approaches for diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity in children. Ann Allergy Asthma Immunol 2019; 123: 389-93.
15. Nohra D, Molinari N, Demoly P, Chiriac AM. Data-driven step doses for drug provocation tests to nonsteroidal anti-inflammatory drugs. Allergy 2020;75:1423-1434.
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