Antibiotics, NSAIDs Reported Most Common Cause of Pediatric Anaphylaxis
Among pediatric patients aged 1 month to 18 years with emergent anaphylaxis, cephalosporins were the leading antibiotics and ibuprofen the top NSAID implicated in a new study.
In a large, multicenter retrospective study of pediatric drug-induced anaphylaxis, antibiotics, and particularly ceftriaxone, were identified as the most common causative agents. Nonsteroidal anti-inflammatory drugs (NSAIDs), led by ibuprofen, constituted the second most frequently implicated drug group.
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These findings underscore the importance of "algorithmic evaluation in pediatric patients experiencing drug-related anaphylaxis to ensure accurate diagnosis, prevent recurrence, and identify safe alternative treatments," study authors wrote in the European Journal of Pediatrics.
The study, from a team of Turkish investigators, analyzed 293 anaphylactic episodes in 265 patients aged 1 month to 18 years admitted to outpatient pediatric allergy and immunology departments with a "presumptive diagnosis of drug-induced anaphylaxis," according the the study.
Investigators reported that antibiotics accounted for 56.7% of suspected drug groups, with ceftriaxone implicated more than 1 in 4 (27.5%) cases. NSAIDs represented 25.7% of causative agents and chemotherapeutics were identified in 3.4% of cases. In more than one-third of cases (39.6%) the anaphylactic episodes were classified as severe, with the balance (54.6%) identified as moderate. Five youths had a biphasic reaction. Notably, only 72% of patients received adrenaline treatment, the authors emphasized, and there were no fatalities recorded.
Diagnostic testing, including skin prick, intradermal, and drug provocation tests, performed at various intervals following the index reaction, confirmed drug-induced anaphylaxis in 39 patients, at 23%, 17.2%, and 20.3%, for the tests, respectively.
The researchers collected data from 11 participating medical centers between January 17 and December 2022. The median age of participating patients during the index episode was approximately 8.9 years and approximately half (48.1%) were girls. Regarding route of administration, medications were taken orally in 40.3% of the situations and parenterally in 59.7%. The team reported that most of the anaphylactic episodes (62.1%) occurred in the hospital setting compared to at home (34.1%).
"To the best of our knowledge, this is the largest multicenter paediatric drug-related anaphylaxis study, involving a large number of patients evaluated by [a] paediatric allergist," the authors wrote. "We propose paediatric patients who experience drug induced anaphylaxis should undergo evaluation at specialized centres," to optimize management and prevent future episodes.
Nearly 60% of fatal anaphylaxis cases have been attributed to drugs, according to a recent review of the mechanisms of drug-induced anaphylaxis.2 The number reflects an increase in incidence, the authors note, that is "consistent with a global increased sensitization to various allergens in the population, including drugs." Anaphylaxis to monoclonal antibodies in particular increased from 2.00% in 1999 to 17.37% in 2019 -- the fastest increase observed among "all the drugs responsible for anaphylaxis."
Evidence for risk factors that increase susceptibility to anaphylaxis is still accruing although not even a history of atopic disease appears to qualify as a consistent threat, according to the review. Whatever the mechanism, however, the first-line treatment of any type of anaphylaxis is epinephrine. As far as therapeutic tools are concerned, the avoidance of the drug is the only efficient
action when possible, they concluded.
