Öz
Amaç: Çalışmamızın amacı, kliniğimize ilaç alerjisi şüphesiyle başvuran hastaların demografik özellikleri, sebep olan ilaçların sıklığı, ilaç alerjisinde tanısal testlerin katkısını belirlemektir.
Gereç ve Yöntem: Çukurova Üniversitesi Hastanesi Çocuk Alerji ve İmmünoloji Kliniği’ne Ocak 2010- Aralık 2015 tarihleri arasında erken tip ilaç alerjisi şüphesiyle başvuran 74 hasta çalışmaya dahil edildi. Hastaların tıbbi kayıtları incelenerek yaş, cinsiyet, şüpheli ilaç(lar), oluşan reaksiyon, şüpheli ilacın uygulama yolu, atopi ve eşlik eden hastalıklar, aile öyküsü, uygulanan tedavi ve tanısal testler retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 74 hastada bildirilen 119 erken tip ilaç aşırı duyarlılık reaksiyonları değerlendirildi. İlaç ile ilişkili olduğu bildirilen en sık reaksiyon ürtiker (%40.2) ardından ürtiker/anjiyoödem (%29.8) ve anafilaksi (%10.3) olarak belirlendi. İlaçlardan sırasıyla en sık beta laktam antibiyotikler (%39.8), nonsteroid anti-inflamatuvarlar ile (%29.3) alerjik reaksiyon öyküsü vardı. Otuzaltı hastada (% 48.6) çoklu ilaç alerjisi öyküsü mevcuttu.
Sonuç: Çalışmamızda beta laktam antibiyotikler en sık reaksiyon tarif edilen ilaçlar olup tanısal testler ile de bu sıklık doğrulanmıştır. Deri test ve/veya spesifik IgE ölçümü ile duyarlılık saptanmayan olgularda dahi tanıyı doğrulamak için ilaç provakasyon testlerinin de yapılması gerektiği saptanmıştır.
Anahtar Kelimeler
İlaç alerjisi erken tip reaksiyon tanısal testler ilaç provakasyon testleri.
Kaynakça
- Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014;69(4):420-37.
- Gelincik A, Özşeker ZF, Çolakoğlu B, Dal M, Büyüköztürk S. Antibiyotiklere bağlı hipersensitivite reaksiyonları: Alternatif antibiyotik saptanmasında provakasyon testlerinin önemi. Asthma Allergy Immunol 2013;11(1):23-31.
- Orhan F, Karakas T, Cakir M ve ark. Parental-reported drug allergy in 6-to 9-yr-old urban school children. Pediatr Allergy Immunol 2008;19(1):82-5.
- Kılıç M, Öztürk F. İlaç Alerjileri. Güncel Pediatri 2009;7(2):76-82.
- Schnyder B. Approach to the patient with drug allergy. Med Clin North Am 2010;94(4):665-79.
- Borch JE, Andersen KE, Bindslev-Jensen C. The prevalence of suspected and challenge-verified penicilin allergy in a university hospital population. Basic Clin Pharmacol Toxicol 2006;98(4):357-62.
- Sade K, Holtzer I, Levo Y, Kivity S. The economic burden of antibiotic treatment of penicillin-allergic patients in internal medicine wards of a general tertiary carehospital. Clin Exp Allergy 2003;33(4):501-6.
- Dona I, Blanca-Lopez N, Torres MJ, et al. Drug hypersensitivitiy reactions: Response patterns, drug involved and temporal variations in a large series of patients. J Investig Allergol Clin Immunol 2012;22(5):363-71.
- Adkinson NF Jr. Risk factors for drug allergy. J Allergy Clin Immunol 1984;74(4):567-72.
- Celik GE, Pichler WJ, Adkinson NF. Drug allergy. Middleton’s Allergy Principles and Practice 8th ed. Philadelphia: Elsevier Saunders; 2014:1274-95.
- Burrows JA, Nissen LM, Kirkpatrick CM, Bell SC. Betalactam allergy in adults with cystic fibrosis. J Cyst Fibros 2007;6(4):297-303.
- Smyth RMD, Gargon E, Kirkham J, et al. Adverse drug reactions in children-A systematic review. PLoS One 2012;7(3):e24061.
- Lange L, Koningsbruggen SV, Rietschel E. Questionnaire-based survey of lifetime-prevalence and character of allergic drug reactions in German children. Pediatr Allergy Immunol 2008;19(7):634-8.
- Erkocoglu M, Kaya A, Civelek E, et al. Prevalance of confirmed immediate type drug hypersensitivity reactions among school children. Pediatr Allergy Immunol 2013;24(2):160-7.
- Lin E, Saxon A, Riedl M. Penicillin allergy: Value of including amoxicilllin as a determinant in penicillin skin testing. Int Arch Allergy Immunol 2010;152(4):313-8.
- Romano A, Mayorga C, Torres MJ, et al. Immediate allergic reactions to cephalosporins: Cross-reactivity and selective responses. J Allergy Clin Immunol 2000;106(6):1177-83.
- Arikoglu T, Aslan G, Batmaz SB, Eskandari G, Helvaci I, Kuyucu S. Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests. Int J Clin Pharm 2015;37(4):583-91.
- Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudo allergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol 2001;87(3):177-80.
- Kidon MI, Kang LW, Chin CW, et al. Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian atopic children. Pediatrics 2005;116(5):675-80.
- Caubet JC, Eigenmann PA. Diagnostic issues in pediatric drug allergy. Curr Opin Allergy Clin Immunol 2012;12(4):341-7.
- Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: From self-reporting to confirmed diagnosis. Clin Exp Allergy 2008;38(3):191-8.
- Weiss MD. Recognising drug allergy. How to differentiate true allergy from other adverse drug reactions? Postgrad Med 2005;117(5):32-6.
- Romano A, Demoly P. Recent advences in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol 2007;7(4):299-303.
- Aberer W, Kranke B. Provocation tests in drug hypersensitivity. Immunol Allergy Clin North Am 2009;29(3):567-84.
- Tugcu GD, Cavkaytar O, Sekerel BE, et al. Actual drug allergy during childhood: Five years' experience at a tertiary referral centre.Allergol Immunopathol (Madr) 2015;43(6):571-8.
- Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 2005;5(4):309-16.
Five-year experience on early type drug reactions in Çukurova University Clinic of Pediatric Allergy
Öz
Aim: The aim of our study is to determine the demographic characteristics of the patients who admitted to our clinic, the frequency of the drugs used and the contribution of diagnostic tests on drug allergy.
Materials and Methods: Seventy-four patients, who admitted to the Çukurova University Clinic of Pediatric Allergy and Immunology between January 2010 – December 2015 with the suspicion of early type drug allergy, were included in the study. The medical records of the patients were reviewed and their age, gender, suspected drug(s), drug’s reaction, the method which was used to apply the drug(s), atopy and accompanying diseases, family history, the treatment method and the diagnostic tests were evaluated retrospectively.
Results: The 119 early type drug hypersensitivity reactions reported in the 74 patients who were included in the study were evaluated. The most common reactions were determined as urticaria (40.2%) followed by urticaria/angioedema (29.8%) and anaphylaxis (10.3%). The drug reactions were respectively beta-lactam antibiotics (39.8%) and nonsteroidal anti-inflammatory drugs (29.3%) and there was also allergic reactions history. Thirty-six patients (48.6%) had multiple drug allergy history.
Conclusion: In our study beta-lactam antibiotics were the most commonly described drugs to show reaction, and this frequency was confirmed through diagnostic tests. It has been determined that drug provocation tests should also be performed in order to confirm the diagnosis even in cases where sensitivity is not detected by skin and/or specific IgE measurement.
Anahtar Kelimeler
Drug allergy early type reaction diagnostic tests drug provocation tests.
Kaynakça
- Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy 2014;69(4):420-37.
- Gelincik A, Özşeker ZF, Çolakoğlu B, Dal M, Büyüköztürk S. Antibiyotiklere bağlı hipersensitivite reaksiyonları: Alternatif antibiyotik saptanmasında provakasyon testlerinin önemi. Asthma Allergy Immunol 2013;11(1):23-31.
- Orhan F, Karakas T, Cakir M ve ark. Parental-reported drug allergy in 6-to 9-yr-old urban school children. Pediatr Allergy Immunol 2008;19(1):82-5.
- Kılıç M, Öztürk F. İlaç Alerjileri. Güncel Pediatri 2009;7(2):76-82.
- Schnyder B. Approach to the patient with drug allergy. Med Clin North Am 2010;94(4):665-79.
- Borch JE, Andersen KE, Bindslev-Jensen C. The prevalence of suspected and challenge-verified penicilin allergy in a university hospital population. Basic Clin Pharmacol Toxicol 2006;98(4):357-62.
- Sade K, Holtzer I, Levo Y, Kivity S. The economic burden of antibiotic treatment of penicillin-allergic patients in internal medicine wards of a general tertiary carehospital. Clin Exp Allergy 2003;33(4):501-6.
- Dona I, Blanca-Lopez N, Torres MJ, et al. Drug hypersensitivitiy reactions: Response patterns, drug involved and temporal variations in a large series of patients. J Investig Allergol Clin Immunol 2012;22(5):363-71.
- Adkinson NF Jr. Risk factors for drug allergy. J Allergy Clin Immunol 1984;74(4):567-72.
- Celik GE, Pichler WJ, Adkinson NF. Drug allergy. Middleton’s Allergy Principles and Practice 8th ed. Philadelphia: Elsevier Saunders; 2014:1274-95.
- Burrows JA, Nissen LM, Kirkpatrick CM, Bell SC. Betalactam allergy in adults with cystic fibrosis. J Cyst Fibros 2007;6(4):297-303.
- Smyth RMD, Gargon E, Kirkham J, et al. Adverse drug reactions in children-A systematic review. PLoS One 2012;7(3):e24061.
- Lange L, Koningsbruggen SV, Rietschel E. Questionnaire-based survey of lifetime-prevalence and character of allergic drug reactions in German children. Pediatr Allergy Immunol 2008;19(7):634-8.
- Erkocoglu M, Kaya A, Civelek E, et al. Prevalance of confirmed immediate type drug hypersensitivity reactions among school children. Pediatr Allergy Immunol 2013;24(2):160-7.
- Lin E, Saxon A, Riedl M. Penicillin allergy: Value of including amoxicilllin as a determinant in penicillin skin testing. Int Arch Allergy Immunol 2010;152(4):313-8.
- Romano A, Mayorga C, Torres MJ, et al. Immediate allergic reactions to cephalosporins: Cross-reactivity and selective responses. J Allergy Clin Immunol 2000;106(6):1177-83.
- Arikoglu T, Aslan G, Batmaz SB, Eskandari G, Helvaci I, Kuyucu S. Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests. Int J Clin Pharm 2015;37(4):583-91.
- Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudo allergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol 2001;87(3):177-80.
- Kidon MI, Kang LW, Chin CW, et al. Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian atopic children. Pediatrics 2005;116(5):675-80.
- Caubet JC, Eigenmann PA. Diagnostic issues in pediatric drug allergy. Curr Opin Allergy Clin Immunol 2012;12(4):341-7.
- Rebelo Gomes E, Fonseca J, Araujo L, Demoly P. Drug allergy claims in children: From self-reporting to confirmed diagnosis. Clin Exp Allergy 2008;38(3):191-8.
- Weiss MD. Recognising drug allergy. How to differentiate true allergy from other adverse drug reactions? Postgrad Med 2005;117(5):32-6.
- Romano A, Demoly P. Recent advences in the diagnosis of drug allergy. Curr Opin Allergy Clin Immunol 2007;7(4):299-303.
- Aberer W, Kranke B. Provocation tests in drug hypersensitivity. Immunol Allergy Clin North Am 2009;29(3):567-84.
- Tugcu GD, Cavkaytar O, Sekerel BE, et al. Actual drug allergy during childhood: Five years' experience at a tertiary referral centre.Allergol Immunopathol (Madr) 2015;43(6):571-8.
- Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol 2005;5(4):309-16.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Eylül 2018 |
| Gönderilme Tarihi | 11 Mayıs 2017 |
| Yayımlandığı Sayı | Yıl 2018 |