Retrospective analysis of the skin and drug provocation test results of the cases diagnosed with the drug reactions

Tıpta Uzmanlık Teziİlaç alerjileri, immunolojik mekanizmalar aracılığıyla oluşan aşırı duyarlılık reaksiyonlarıdır. Ülkemizde, özellikle çocukluk yaş grubunda ilaç alerjilerini değerlendiren az sayıda araştırma mevcuttur. Bu nedenle çalışmamızda ilaç reaksiyonu öyküsüyle başvuran çocuk olgulardaki demografik ve klinik özellikleri, gerçek ilaç alerjisi sıklığını, en sık sorumlu ilaçları ve tanıda deri ile provokasyon testlerinin önemini araştırmayı amaçladık. Bu çalışma, Trakya Üniversitesi Tıp Fakültesi Çocuk Alerji Polikliniğine ilaç reaksiyonu nedeniyle başvuran, klinik öyküleriyle ilaç alerjisi dışlanamayarak deri ve/veya provokasyon testleri yapılan 27 çocuk olgunun poliklinik dosyalarının ve `European Network of Drug Allergy' tarafından oluşturulan ilaç alerjisi anamnez formlarının geriye dönük incelenmesi ile yürütülmüştür. Araştırma sonucunda reaksiyonlardan çoğunlukla beta laktam grubu ilaçların sorumlu olduğu belirlendi. Yaş, cinsiyet, deri döküntüsünün tipi, anafilaksi gelişmesi, son dozla reaksiyon arasında geçen süre, reaksiyon ile testlerin uygulanması arasında geçen süre, ilacın uygulanma şekli, kişide ya da ebeveynlerinde allerjik bir hastalık veya ilaç reaksiyonu öyküsü olması gibi değişkenlerle ilaç alerjisi sıklığı arasında anlamlı ilişki saptanmadı. Yüzde yirmi üçünde beta laktamlara karşı olmak üzere, olguların %29.6'sına ilaç alerjisi tanısı konulduğu belirlendi. Deri prik testlerin tüm olgularda negatif; intradermal testlerin ise 2'si beta laktam alerjili olmak üzere toplam 3 olguda (%11.1) erken okumada pozitif sonuçlandığı saptandı. İlaç provokasyon testlerinin, %19.2'sinde betalaktamlara karşı olmak üzere toplam %22 olguda pozitif sonuçlandığı ayrıca beta laktam alerjisi olan olguların %66'sına ancak provokasyon testi ile tanı konulabildiği belirlendi. İlaç alerjisi tanısı sadece öyküye dayalı olarak konulmamalı, şüpheli olgularda öncelikle ilaç deri testleri yapılmalıdır. Deri testleri negatif sonuçlanan olgularda kontrendikasyon taşıyan durumlar yoksa ilaç provokasyon testleri uygulanmalıdır.AbstractDrug allergy is defined as hypersensitivity reactions mediated by immunological mechanisms. There is limited research in our country evaluating drug allergic reactions in children . Therefore, we aimed to investigate the demographic and clinical characteristics and the true drug allergy prevelance in the children diagnosed with the drug reactions, the most commonly incriminated drugs related to the reactions, and the emphasis of skin and drug provocation tests in diagnostic work up. This study was conducted in the Pediatric Alergy Department of Trakya University Medical Faculty Hospital. All 27 children with the history of drug reactions were included in the study. The history alone was not able to exclude drug allergic reactions and therefore skin and drug provocation tests were performed with the suspected and the cross reactive drugs. The medical records and the European Allergy of Drug Network Drug Allergy Questionnare Forms of the cases were evaluated retrospectively. Betalactam antibiotics were responsible in most of the reactions. There was not a significiant relationship between the percentage of drug test positivity and the variables like age, gender, the type of skin lesions, having anaphylactic reactions, the time interval between the last drug administiration and the reaction, the drug administiration route, personal and familal atopy or past drug reactions. Drug allergy was diagnosed in 29.6% of the cases while 23% of them were beta lactam allergic. İntradermal test results were positive in 3 cases (in two beta lactams) (11.1%) while all skin prick tests were negative. Drug provocation test positivity rates were 23% and 19.2% in all drugs and beta lactam antibiotics respectively. Sixty six percent of the beta lactam allergic cases could be diagnosed just by drug provocation tests. Diagnosis of drug allergy shouldn?t only rely on the patient's history . Firstly, drug skin tests must be perfomed on the individuals with suspected drug allergic reactions. The negative skin test results should be followed by drug provocation tests in the individuals with no contraindicate conditions

Food-induced anaphylaxis in early childhood and factors associated with its severity.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified

Food-induced anaphylaxis in early childhood and factors associated with its severity

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods:We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension