Allergy, Asthma & Respiratory Disease

  • 제6권1호
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  • Pages.26-33
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  • 2018
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  • 2288-0402(pISSN)
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  • 2288-0410(eISSN)
대한천식알레르기학회 (The Korean Academy of Asthma, Allergy and Clinical Immunology)
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약물과민반응이 의심되는 한국 소아에서 약물유발검사 결과

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

  • 노수란 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 윤지선 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 조현주 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 송승윤 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 박근미 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 유진호 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터) ;
  • 홍수종 (울산대학교 의과대학 서울아산병원 소아청소년과 소아천식아토피 센터)
  • Noh, Soo Ran (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Jisun (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Hyun-Ju (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Seongyoon (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Geun-Mi (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Jinho (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Soo-Jong (Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2017.06.05
  • 심사 : 2017.08.23
  • 발행 : 2018.01.31
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

참고문헌

  1. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004;113:832-6. https://doi.org/10.1016/j.jaci.2003.12.591
  2. Khan DA, Solensky R. Drug allergy. J Allergy Clin Immunol 2010;125(2 Suppl 2):S126-37. https://doi.org/10.1016/j.jaci.2009.10.028
  3. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58:854-63. https://doi.org/10.1034/j.1398-9995.2003.00279.x
  4. Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol 2001;1:305-10. https://doi.org/10.1097/01.all.0000011031.16814.e0
  5. Seitz CS, Brocker EB, Trautmann A. Diagnosis of drug hypersensitivity in children and adolescents: discrepancy between physician-based assessment and results of testing. Pediatr Allergy Immunol 2011;22:405-10. https://doi.org/10.1111/j.1399-3038.2011.01134.x
  6. Vezir E, Erkocoglu M, Civelek E, Kaya A, Azkur D, Akan A, et al. The evaluation of drug provocation tests in pediatric allergy clinic: a single center experience. Allergy Asthma Proc 2014;35:156-62. https://doi.org/10.2500/aap.2014.35.3744
  7. Aun MV, Bisaccioni C, Garro LS, Rodrigues AT, Tanno LK, Ensina LF, et al. Outcomes and safety of drug provocation tests. Allergy Asthma Proc 2011;32:301-6. https://doi.org/10.2500/aap.2011.32.3450
  8. Messaad D, Sahla H, Benahmed S, Godard P, Bousquet J, Demoly P. Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med 2004;140:1001-6. https://doi.org/10.7326/0003-4819-140-12-200406150-00009
  9. Na HR, Lee JM, Jung JW, Lee SY. Usefulness of drug provocation tests in children with a history of adverse drug reaction. Korean J Pediatr 2011; 54:304-9. https://doi.org/10.3345/kjp.2011.54.7.304
  10. Choi J, Lee JY, Kim KH, Choi J, Ahn K, Kim J. Evaluation of drug provocation tests in Korean children: a single center experience. Asian Pac J Allergy Immunol 2016;34:130-6.
  11. Simons FE, Ardusso LR, Dimov V, Ebisawa M, El-Gamal YM, Lockey RF, et al. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. Int Arch Allergy Immunol 2013;162:193-204. https://doi.org/10.1159/000354543
  12. Simons FE, Ardusso LR, Bilo MB, Cardona V, Ebisawa M, El-Gamal YM, et al. International consensus on (ICON) anaphylaxis. World Allergy Organ J 2014;7:9. https://doi.org/10.1186/1939-4551-7-S1-P9
  13. Mirakian R, Ewan PW, Durham SR, Youlten LJ, Dugue P, Friedmann PS, et al. BSACI guidelines for the management of drug allergy. Clin Exp Allergy 2009;39:43-61. https://doi.org/10.1111/j.1365-2222.2008.03155.x
  14. Rubio M, Bousquet PJ, Gomes E, Romano A, Demoly P. Results of drug hypersensitivity evaluations in a large group of children and adults. Clin Exp Allergy 2012;42:123-30. https://doi.org/10.1111/j.1365-2222.2011.03887.x
  15. Indradat S, Veskitkul J, Pacharn P, Jirapongsananuruk O, Visitsunthorn N. Provocation proven drug allergy in Thai children with adverse drug reactions. Asian Pac J Allergy Immunol 2016;34:59-64.
  16. Park GM, Han HW, Kim JW, Hwang KH, Lee E, Yang SI, et al. Delayed urticaria caused by lidocaine in a child. Allergy Asthma Respir Dis 2014; 2:298-301. https://doi.org/10.4168/aard.2014.2.4.298

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