Macrolide Allergy in Children and the Negative Predictive Value of Drug Provocation Tests in Mild Index Reactions

IF 0.3 Q4 ALLERGY

Astim Allerji Immunoloji Pub Date : 2021-08-20 DOI:10.21911/aai.655

B. Karaatmaca, Şule Büyük Yaytokgil, I. K. Celik, O. Y. Topal, E. Civelek, M. Toyran, E. Misirlioglu

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Abstract

ABSTRACT Objective: Macrolide allergy is rarely reported, and there is limited knowledge of hypersensitivity reactions (HRs) in children. The negative predictive value (NPV) of drug provocation tests (DPTs) for macrolides is unresolved. We aim to evaluate the clinical features of macrolide allergy in children, and determine the NPV of macrolide DPTs. Materials and Methods: Pediatric patients who were referred to our allergy department with a suspicion of macrolide allergy were evaluated by DPTs with or without prior skin tests between 2011 and 2020. Characteristics of the HRs and patients, the results of skin and DPTs were recorded. At least three months after evaluation of the patients with allergy work up, telephone interviews were performed. Patients were asked whether they had reused the suspected macrolide or not. Patients who reported HR during subsequent drug intake were invited for reevaluation. Results: A total of 160 children (161 reactions) (55.6% male) with a suspicion of macrolide allergy were enrolled for the study, and all children had a mild index reaction. The median age was 48 (18-102) months, and the median time between the suspected allergic reaction and allergy work-up was 3 (2-8) months. The most frequently reported suspected agent was clarithromycin, in 151 patients (94.4%). Macrolide allergy was confirmed in 8 (5%) patients. Only one patient reported skin eruptions upon reuse despite a negative DPT and he was invited to be reevaluated. A second DPT was performed resulting in urticarial lesions. The NPV was found to be 97.4% for negative DPT with macrolides. Conclusion: Confirmed macrolide allergy is rare in children, and DPTs are the gold standard to assess suspected macrolide allergy. The NPV of macrolide provocation tests seems to be high in children. Keywords: Children, drug hypersensitivity, drug provocation test, macrolide, negative predictive value

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儿童大环内酯类过敏及药物刺激试验对轻度指标反应的阴性预测价值

摘要目的：大环内酯类过敏的报道较少，对儿童超敏反应的了解也有限。药物激发试验（DPTs）对大环内酯类药物的阴性预测值（NPV）尚未解决。我们的目的是评估儿童大环内酯类过敏的临床特征，并确定大环内酯DPTs的NPV。材料和方法：在2011年至2020年间，对转诊至我们过敏科的疑似大环内酯类过敏的儿科患者进行DPT评估，无论是否进行过皮肤测试。记录HRs和患者的特征、皮肤和DPTs的结果。在对过敏患者进行评估后至少三个月，进行了电话采访。询问患者是否重复使用了疑似大环内酯类药物。在随后的药物摄入过程中报告HR的患者被邀请进行重新评估。结果：共有160名疑似大环内酯类过敏的儿童（161种反应）（55.6%为男性）参加了这项研究，所有儿童都有轻度指数反应。中位年龄为48（18-102）个月，疑似过敏反应和过敏检查之间的中位时间为3（2-8）个月。151名患者（94.4%）中最常报告的疑似药物是克拉霉素。8名患者（5%）被证实对大环内酯过敏。尽管DPT呈阴性，但只有一名患者在重复使用时报告皮肤出疹，并邀请他进行重新评估。进行了第二次DPT，导致荨麻疹病变。大环内酯类药物阴性DPT的NPV为97.4%。结论：证实的大环内酯类过敏在儿童中很少见，DPTs是评估疑似大环内酯过敏的金标准。大环内酯类刺激试验的NPV在儿童中似乎很高。关键词：儿童；药物超敏反应；药物激发试验；大环内酯类；阴性预测值

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来源期刊

Astim Allerji Immunoloji ALLERGY-

CiteScore

0.80

自引率

0.00%

发文量

期刊介绍： Asthma Allergy Immunology has been published three times a year in April, August and December as the official and periodical journal of the Turkish National Society of Allergy and Clinical Immunology since 2003. All articles published in the journal have been available online since 2003. A peer reviewed system is used in evaluation of the manuscripts submitted to Asthma Allergy Immunology. The official language of the journal is English. The aim of the journal is to present advances in the field of allergic diseases and clinical immunology to the readers. In accordance with this goal, manuscripts in the format of original research, review, case report, articles about clinical and practical applications and editorials, short report and letters to the editor about allergic diseases and clinical immunology are published in the journal. The target reader population of the Asthma Allergy Immunology includes specialists and residents of allergy and clinical immunology, pulmonology, internal medicine, pediatrics, dermatology and otolaryngology as well as physicians working in other fields of medicine interested in allergy and immunological diseases.