![]() The rate of drug-induced anaphylaxis is increasing: A United States retrospective analysis showed a 212% increase in drug-related anaphylaxis (479%, age 0–4 years 140%, age 5–17 years) from 2005 to 2014. The frequency of drug-related anaphylaxis is 5%–25% of all anaphylaxis cases according to different reports, including a multicenter retrospective review of anaphylaxis in Korea revealing that 10% of anaphylaxis triggers are drugs. Isolated respiratory reactions are mostly restricted to NSAIDs but may also present as a part of anaphylaxis. Gastrointestinal symptoms included nausea, vomiting, diarrhea, or constipation ( Table 2). Cutaneous symptoms include urticaria, angioedema, and for some drugs, such as sulfonamides, fixed drug eruptions. In children, cutaneous symptoms, especially maculopapular eruptions (MPEs), are the most frequently reported reactions, followed by gastrointestinal symptoms. However, the characteristics of the subject group can largely affect adverse reaction frequency and type. The common culprit drugs causing DHs in children are antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), antiepileptic drugs (AEDs), and vaccines. In contrast to DH in adult patients, the process of collecting and reporting DH largely depends on the parents’ perception, and it is not evident whether the missing rate is higher in children. In a Turkish survey, the incidence of the parent-reported immediate type DH was 7.87% however, after diagnostic workup, the true frequency was 0.11%. According to a nationwide Korean questionnaire, the prevalence of DA symptoms in school children was 4.4%, but the prevalence of diagnosed DA was only 1.1%. However, among the reported ADRs, the proportion of confirmed DA is as low as 4% after diagnostic evaluation. The prevalence of reported ADR in children is lower than that in adults in the range of 2.9%–16.8% according to different reports ( Table 1). Īccurate data on the epidemiology of ADR, DH, and DA are rare in children, with most epidemiologic data including both type A and B reactions. DAs are classified according to the Gell and Coombs system of hypersensitivity into type I (drug-specific immunoglobulin E antibodies), type II (cytotoxic reactions mediated by drug-specific immunoglobulin G antibodies), type III (immune complex reactions), and type IV reactions (delayed-type hypersensitivity reactions mediated by cellular immunity). ![]() Clinically, DHs are classified as immediate DH, which occur within 1–6 hours after the last drug administration, and nonimmediate DH, which occur at any time from 1 hour after the initial drug administration. When DA is suspected, DH is the preferred term. DAs are DHs for which a definite immunological mechanism has been demonstrated ( Fig. DHs, part of type B reactions, are adverse effects of drugs that clinically resemble allergic reactions. Type B reactions are less common, dose-independent, unpredictable, and unrelated to the drug’s pharmacological action. Type A reactions are dose-dependent predictable consequences of the known pharmacological action of the drug that account for 80% of ADR cases. 1, ADRs are traditionally divided into type A and type B reactions. Adverse drug reaction (ADR) is defined by the World Health Organization as “a response to a drug which is noxious, and unintended, which occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease, or for the modification modification of physiological function.” As shown in Fig. ![]()
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