Allergy Asthma Respir Dis.  2018 Jan;6(1):26-33. 10.4168/aard.2018.6.1.26.

Outcomes of drug provocation tests in Korean children with suspected drug hypersensitivity reaction

• Noh SR
• Yoon J
• Cho HJ
• Song S
• Park GM
• Yu J
• Hong SJ

• KMID: 2403182
• DOI: http://doi.org/10.4168/aard.2018.6.1.26

Abstract

PURPOSE
Drug provocation tests (DPT) are the gold standard for confirming the diagnosis of drug hypersensitivity reactions (DHRs). However, there are little studies of DPT in children. The purpose of this study was to evaluate DPT results and safety as diagnostic methods of DHR in Korean children.
METHODS
We reviewed the medical records of 39 children under 18 years of age with a suspected DHR and performed DPT between January 2010 and May 2016 at Asan Medical Center.
RESULTS
Total 110 DPT were performed in 39 children (20 boys and 19 girls) with a history of DHR. Clinical presentation of DHR included skin rash (n=7), pruritus (n=3), urticaria (n=18), angioedema (n=19), dyspnea (n=5), hoarseness (n=1), hypothermia (n=1), and anaphylaxis (n=5). The median age at the time of DPT was 9 years. Positive DPT were observed in 21 of 39 children (53.8%) and 28 of 110 cases (25.5%). Drugs causing positive reactions were acetaminophen in 50% (9 of 18), nonsteroidal anti-inflammatory drugs in 29.2% (14 of 48), cephalosporin in 9.1% (1 of 11), trimethoprim/sulfamethoxazole in 50% (1 of 2), local anesthetics in 10% (1 of 10), and others (levodropropizine and idursulfase) in 15.4% (2 of 13). There was no statistical difference between children who had positive and negative results in sex, age, personal and parental history of allergic disease, eosinophil count, or total IgE level. Children with positive DPT did not develop anaphylaxis during the DPT procedure.
CONCLUSION
Drug provocation test is safe, and it can be considered in children with suspected DHRs.

Keyword

Drug hypersensitivity reaction; Drug provocation test; Child

MeSH Terms

Acetaminophen
Anaphylaxis
Anesthetics, Local
Angioedema
Child*
Chungcheongnam-do
Diagnosis
Drug Hypersensitivity*
Dyspnea
Eosinophils
Exanthema
Hoarseness
Humans
Hypothermia
Immunoglobulin E
Medical Records
Parents
Pruritus
Urticaria
Acetaminophen
Anesthetics, Local
Immunoglobulin E

Figure

• 

  Fig. 1. Number of suspected and proven drug hypersensitivity reaction. DPT, drug provocation test; AAP, acetaminophen; NSAID, nonsteroidal anti-inflammatory drug; TMP/SMX, trimethoprim/sulfamethoxazole; Others, varidase, serratiopeptidase, salbutamol, ipratropium, formoterol, folic acid, Lactobacillus acidophilus, domperi-done, rebamipide, pinaverium, levodropropizine, and idursulfase.

• 

  Fig. 2. Drug allergy card and application.

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