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The Contradiction of Drug Allergy in Patients with Cystic Fibrosis and Review of the Literature
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  • Gokcen Dilsa Tugcu,
  • Nagehan Emiralioğlu,
  • Ebru Yalçın,
  • Umit Sahiner,
  • Deniz Doğru,
  • Bulent Sekerel,
  • Uğur Özçelik,
  • Nural Kiper,
  • Ozge Soyer
Gokcen Dilsa Tugcu
Hacettepe University Faculty of Medicine

Corresponding Author:gokcendtugcu@gmail.com

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Nagehan Emiralioğlu
Hacettepe University Faculty of Medicine
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Ebru Yalçın
Hacettepe University, İhsan Dogramacı Children's Hospital
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Umit Sahiner
Hacettepe University Faculty of Medicine
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Deniz Doğru
Hacettepe University, İhsan Dogramacı Children's Hospital
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Bulent Sekerel
Hacettepe University, İhsan Dogramacı Children's Hospital
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Uğur Özçelik
Hacettepe University, İhsan Dogramacı Children's Hospital
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Nural Kiper
Hacettepe University, İhsan Dogramacı Children's Hospital
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Ozge Soyer
Hacettepe University School of Medicine, Ihsan Dogramaci Children's Hospital
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Abstract

Background: Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there is conflicting data about true prevalence of drug allergy in children with CF. Methods: The suspicious drug hypersensitivity reactions (DHR) of children with CF were enquired by European Network for Drug Allergy (ENDA) questionnaire and skin tests and/or drug provocation tests were performed according to established guidelines. Results: Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, from whom 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were non-immediate (n=16, 66.6%) type and the offending drugs were amoxicillin clavulanic acid (n=7), macrolides (n=4), trimethoprim sulfamethoxazole (TMP/SMX) (n=2), piperacillin tazobactam (n=1), pancrelipase (n=1) and ursodeoxycholic acid (n=1). Eight (33.3%) of the DHRs were classified as immediate [ceftriaxone (n=2), ceftazidim (n=2), meropenem (n=1), ambisome (n=2), vancomycin (n=1)]. The main presenting clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%) and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed and none of the skin tests revealed a positive result, however 2 DPTs with TMP/SMX were positive. Conclusion: Actual drug allergy was demonstrated in 2 of 219 patients (0.9%) with nonbeta-lactam antibiotics. These results conflict with previous researches that showed higher drug allergy rates but were consistent with some recent studies. Numerous and long-term use of multiple drugs during management of cystic fibrosis may contribute to tolerance development.
08 Mar 2021Submitted to Pediatric Allergy and Immunology
10 Mar 2021Reviewer(s) Assigned
05 May 2021Review(s) Completed, Editorial Evaluation Pending
06 May 2021Editorial Decision: Revise Major
02 Aug 20211st Revision Received
03 Aug 2021Review(s) Completed, Editorial Evaluation Pending
04 Aug 2021Reviewer(s) Assigned
14 Sep 2021Editorial Decision: Revise Minor
05 Dec 20212nd Revision Received
06 Dec 2021Review(s) Completed, Editorial Evaluation Pending
08 Dec 2021Editorial Decision: Accept