Çocuklarda beta-laktam antibiyotiklere aşırı duyarlılık şüphesi ve çocuk alerji klinik deneyimleri
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Date
2021-01-25
Authors
Ertuğrul, Ayşegül
Başkaya, Nevzat
Esenboğa, Saliha
Özmen, Serap
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Giriş: Çocuklarda ilaca bağlı aşırı duyarlılık reaksiyonlarına en sık neden gösterilen ilaçlar beta-laktam antibiyotiklerdir (BLA). Ancak, hastaların %95’inden fazlası uygun bir şekilde değerlendirildiğinde güvenle penisilin grubu ilaçları kullanabilmektedir. Bu çalışmada şüpheli BLA alerjisi nedeniyle başvurmuş hastaların klinik özelliklerini, ilaç alerjisine yönelik yapılan tanısal testleri ve sonuçları incelenerek gerçek BLA alerjisi sıklığını değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmada, üçüncü basamak bir sağlık merkezinde çocuk alerji polikliniğine, bir yıllık sürede, şüpheli BLA alerjisi nedeniyle başvurmuş 44 çocuk retrospektif olarak değerlendirildi. Bulgular: Çalışmaya BLA alerjisi şüphesi ile toplam 44 çocuk (kız/erkek: 24/20) dahil edildi. Hastaların %38,6’sında (n=17) alerjik hastalık öyküsü, %36,4’ünde (n=16) ailede alerjik hastalık öyküsü vardı. En sık bildirilen şüpheli ilaç amoksisilin klavulonat (%75), en sık antibiyotik kullanım nedeni akut tonsillit (%56,8) idi. En yaygın klinik tabloyu cilt bulguları (%97,7) oluşturmaktaydı. Yapılan alerjik değerlendirme sonucunda toplam 5 hastada (%11) BLA alerjisi saptandı. BLA alerjisi saptanan çocuklar ile saptanmayanlar arasında yaş, cinsiyet, atopi öyküsü ya da ailede ilaç alerjisi öyküsü varlığı açısından anlamlı bir farklılık saptanmadı (p>0,05). Sonuç: Tanısal değerlendirme sonrası, sadece öykü ile şüpheli alerjik reaksiyon kabul edilecek olguların gerçekte az bir kısmında BLA aşırı duyarlılığı olduğu gösterilmiştir. BLA’lara karşı alerjik reaksiyon öyküsü olan çocuklarda doğru tanıyı güvenle ortaya koymak ve hastaları gereksiz yere ilaç alerjisi tanısıyla etiketlememek için ayrıntılı bir klinik öykü doğrultusunda uygun ilaç alerjisi değerlendirmesi gerekmektedir.
Introduction: Beta-lactam antibiotics (BLA) are the most common drugs that cause drug-related hypersensitivity reactions in children. However, more than 95% of patients can safely use penicillins when properly evaluated. In this study, we aimed to evaluate the actual frequency of BLA allergy by examining the clinical characteristics of the patients, diagnostic evaluation of drug allergy tests and results in patients presenting with suspected BLA allergy. Materials and Methods: In the study, 44 children who admitted to a pediatric allergy outpatient clinic in a tertiary care center with suspected BLA allergy in a one-year period were evaluated retrospectively. Results: A total of 44 children (male/female: 24/20) with suspected BLA allergy were included in the study. 38.6% (n=17) of the patients had a history of allergic disease, 36.4% (n=16) had a family history of allergic disease. The most frequently reported culprit drug was amoxicillin clavulonate (75%) and the most common cause of antibiotic usage was acute tonsillitis (56.8%). Skin findings (97.7%) were the most common clinical presentation. As a result of the allergic evaluation, a total of 5 patients (11%) were found to have BLA allergy. There was no significant difference between children with BLA allergy and those who were not, in terms of age, gender, atopy or family history of drug allergy (p>0.05). Conclusions: After diagnostic evaluation, it has been shown that BLA hypersensitivity is actually present in a small number of cases that are considered to be suspected allergic reactions only with history. In children with a history of allergic reactions to BLAs, an appropriate drug allergy assessment is required in line with a detailed clinical history in order to establish the correct diagnosis confidently and not to label patients with a diagnosis of drug allergy unnecessarily.
Introduction: Beta-lactam antibiotics (BLA) are the most common drugs that cause drug-related hypersensitivity reactions in children. However, more than 95% of patients can safely use penicillins when properly evaluated. In this study, we aimed to evaluate the actual frequency of BLA allergy by examining the clinical characteristics of the patients, diagnostic evaluation of drug allergy tests and results in patients presenting with suspected BLA allergy. Materials and Methods: In the study, 44 children who admitted to a pediatric allergy outpatient clinic in a tertiary care center with suspected BLA allergy in a one-year period were evaluated retrospectively. Results: A total of 44 children (male/female: 24/20) with suspected BLA allergy were included in the study. 38.6% (n=17) of the patients had a history of allergic disease, 36.4% (n=16) had a family history of allergic disease. The most frequently reported culprit drug was amoxicillin clavulonate (75%) and the most common cause of antibiotic usage was acute tonsillitis (56.8%). Skin findings (97.7%) were the most common clinical presentation. As a result of the allergic evaluation, a total of 5 patients (11%) were found to have BLA allergy. There was no significant difference between children with BLA allergy and those who were not, in terms of age, gender, atopy or family history of drug allergy (p>0.05). Conclusions: After diagnostic evaluation, it has been shown that BLA hypersensitivity is actually present in a small number of cases that are considered to be suspected allergic reactions only with history. In children with a history of allergic reactions to BLAs, an appropriate drug allergy assessment is required in line with a detailed clinical history in order to establish the correct diagnosis confidently and not to label patients with a diagnosis of drug allergy unnecessarily.
Description
Keywords
Çocuk, Beta-laktam alerjisi, Penisilin alerjisi, İlaç, Alerji, Beta-lactam allergy, Penicillin allergy
Citation
Ertuğrul, A. vd. (2021). ''Çocuklarda beta-laktam antibiyotiklere aşırı duyarlılık şüphesi ve çocuk alerji klinik deneyimleri''. Güncel Pediatri, 19(1), 1-8.