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TOPLINE:

Drug hypersensitivity (DHS) was suspected in 28 of 250 children with chronic spontaneous urticaria (CSU), but diagnostic testing confirmed true hypersensitivity in only 14 cases, corresponding to an overall prevalence of 5.6%. Beta-lactam antibiotics were the leading confirmed agents, accounting for more than half of the confirmed cases, followed by nonsteroidal anti-inflammatory drugs and paracetamol.

METHODOLOGY:

• Researchers conducted a nested case-control study at a tertiary referral center in Istanbul, Turkey, involving 250 children with CSU followed between January 2018 and December 2023.
• A total of 28 children (11.2%; 95% CI, 7.9%-15.7%) were identified as having suspected DHS based on structured clinical assessment guided by the European Network for Drug Allergy/Global Allergy and Asthma European Network framework.
• All 28 children with suspected DHS underwent diagnostic evaluation including skin prick tests, intradermal tests, and drug provocation tests with culprit and alternative drugs, performed during stable periods after ≥ 7 days without antihistamines.
• Children with confirmed DHS were compared with those in whom DHS was excluded after diagnostic workup and an age- and sex-matched control group of 48 CSU children without a history of DHS, with a case-to-control ratio of 1:3.4.
• Outcome measures included demographic data, clinical characteristics, laboratory parameters (complete blood count, serum total immunoglobulin E [IgE], thyroid autoantibodies, and autologous serum skin test results), and results of drug skin testing and provocation tests.

TAKEAWAY:

• Among the 28 children with suspected DHS, 14 (50%) were confirmed by diagnostic evaluation, with beta-lactams identified as the leading agents (58.3%), followed by nonsteroidal anti-inflammatory drugs/paracetamol (33.3%).
• Selective hypersensitivity was identified in seven patients to antibiotics (2.8% of total cohort) and in four to nonsteroidal anti-inflammatory drugs/paracetamol (1.6%), whereas three patients (1.2%) had multiple DHS.
• Among confirmed beta-lactam hypersensitivity cases, cephalosporins were implicated in six cases and amoxicillin-clavulanic acid in five cases, with one child exhibiting hypersensitivity to both agents.
• In univariate logistic regression analysis, concomitant asthma was associated with confirmed DHS (odds ratio [OR], 3.477; 95% CI, 1.003-12.052; P = .049), though this association was not statistically significant in the multivariate enter model (OR, 3.040; 95% CI, 0.758-12.185; P = .116).

IN PRACTICE:

“The higher confirmation rate in our cohort suggests that DHS may be more common in children with CSU who have a suggestive drug history. Clinical history therefore deserves closer attention in this group. This finding may be related to disease-specific immune features of CSU, including multiple mast cell-activating pathways such as functional IgG antibodies, complement-derived mediators, coagulation-related factors, and IgE- independent activation via MRGPRX2,” the authors of the study wrote.

SOURCE:

This study was led by Sibel Gürbüz, Division of Pediatric Allergy and Immunology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. It was published online in Pediatric Allergy and Immunology.

LIMITATIONS:

The single-center design may have limited generalizability of the findings to other populations and healthcare settings. The small number of confirmed DHS cases (14 patients) reduced statistical power, restricted subgroup analyses, and limited the stability of regression estimates, making it difficult to draw definitive conclusions about risk factors. The exploratory nature of the regression analysis and sensitivity of estimates to model specification mean that the suggested association between concomitant asthma and confirmed DHS should be interpreted cautiously. Selection bias may be present as the study was conducted at a tertiary referral center with a clinically selected cohort of children with CSU and credible drug histories, which may not represent the broader pediatric CSU population.

DISCLOSURES:

No specific funding from any public, commercial, or not-for-profit funding agencies was received for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.