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

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 be tween 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 in cluded 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-in flammatory drugs in 29.2% (14 of 48), cephalosporin in 9.1% (1 of 11), trimethoprim/sulfamethoxazole in 50% (1 of 2), local anes thetics 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 to tal 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. (Allergy Asthma Respir Dis 2018;6:26-33)