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Médecine thérapeutique / Pédiatrie

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Allergic (like) reactions to anti-infective drugs in children: from suspicion to proof Volume 20, issue 2, Avril-Mai-Juin 2017

Author
MCU-PH (retraité), Hôpital Necker-Enfants Malades, Faculté de Médecine Paris Descartes, service de pneumo-allergologie pédiatrique, 149 rue de Sèvres, 75015 Paris, France
* Tirés à part

Seven to 15% of children report suspected allergic/hypersensitivity (HS) reactions to drugs, antibiotics especially, but studies based on clinical history, skin tests (ST) and drug challenge/provocation tests (DPT) have shown that only 10-15% of these children were truly allergic, except for the children reporting immediate and/or severe reactions.

Diagnosis is usually based on a careful analysis of the clinical history, ST and DPT, but many authors currently recommend prolonged DPT with the suspected drugs as a first-line diagnostic test in non-immmediate and non-severe reactions because the diagnostic value of non-immediate-reading ST, the risk of a reaction during DPT, and, if such a reaction occurs, the risk of a severe reaction are low.

Before the allergological work-up is performed, eviction of all drugs in the same and closely related classes is recommended in children reporting immediate and/or anaphylactic reactions, because there is a high risk of cross-reactivity, except for macrolides. In mild to moderately severe non-immediate reactions, other drugs in the other classes of the same family can be prescribed safely because the risk of cross-reactivity is low.

Most children reporting allergic-like reactions to several families or classes of antibiotics are not allergic to drugs.