SRINAGARIND MEDICAL JOURNAL

Volume 35, No. 04, Month JULY, Year 2020, Pages 397 - 403

Clinical presentation and outcomes of pediatrics patients undergoing evaluation for drug allergy in ramathibodi hospital

Dara Mairiang, Wiparat Manuyakorn, Suwat Benjaponpitak, Soamarat Vilaiyuk, Wasu Kamchaisatian, Cherapat Sasisakulporn, Wanlapa Jotikasthira

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Background and objectives: Drug allergy is a major problem frequently encountered. Patients are frequently over diagnosed as having drug allergy without proper confirmatory tests. The aims of this study were to assess prevalence, clinical presentation and outcomes among pediatric patients suspected of having a drug allergy form medical history, and undergoing drug allergy evaluation. Methods: Medical records of pediatric patients who had undergone evaluation for drug allergy in Ramathibodi Hospital were reviewed. Patients were confirmed to have a true drug allergy by a positive skin test and/ or drug provocation test. Results: Sixty patients were evaluated for drug allergy. Onset of symptoms was highly variable (median 4.5 hours; min-max 0.08-168). Skin and mucocutaneous reactions were the most common presentations (95%) particularly angioedema and urticaria (66.7%). The most common suspected group of drugs was antibiotics (71.7%), followed anti-pyretic/anti-inflammatory (11.7%) and respiratory drugs (6.7%). Within the group of antibiotics, Beta-lactam antibiotic was the most common suspected drug causing allergy. Only sixteen out of sixty patients (26.7%) were confirmed to have a true drug allergy, 12 patients by skin test and 4 patients by drug provocation test. Drug provocation test reactions did not correlate with presenting symptoms of drug allergy. There were no significant differences in age, onset or primary symptoms of drug allergy between the confirmed true drug allergy and no drug allergy groups. Conclusions: Drug allergy is frequently reported, but only a minority of patients have true drug allergy. There were no precise clinical predictors for drug allergy. Thus, drug provocation tests remain the gold standard for diagnosis.

Keywords

drug allergy, drug provocation test, clinical presentation of drug allergy

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