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Skin Rashes After Antibiotic Use LIST AND CONTENTS OF ANTIMICROBIALS ALLEGED TO CAUSE ADVERSE REACTIONS
Source publication
Immunoglobulin E (IgE)-mediated drug sensitivity in children is uncommon. However, undefined skin rash following antibiotic ingestion in younger children is commonly observed in clinical practice. We studied 86 consecutively referred patients to our allergy clinic over a 5-year period. We found that the majority of children (80%) with skin rashes w...
Contexts in source publication
Context 1
... half of them took ibuprofen only after Tylenol® failed to help defervesce in 5 days. Table 2 lists the antibi- otics reported to have caused the skin rash, along with their dyes and flavors in the suspension. ...
Context 2
... may simply reflect the fact that penicillin drugs are still the most commonly prescribed antibiotics in pediatric practice today. Among all the drugs listed in Table 2,, it is noteworthy that only Suprax® and Pediazole® do not have dye in the liquid form. The fact that most liquid antibi- otics contain dyes may be impor- tant, because some dyes are known to cause adverse effects such as skin rash.*>.' ? ...
Citations
... CADRs are confirmed with a drug challenge in a very low number of cases (92,93). Furthermore, the anxiety of parents could mislead the clinician to consider the child "allergic" to a drug (7). ...
Adverse reactions to drugs are not frequent in childhood. Cutaneous reactions are the most frequent in this age group. Mild cutaneous reactions are immediate or delayed adverse reactions that do not seriously compromise the clinical condition of children. The patients usually early improve and recover the state of health. Although it is difficult to define the prevalence accurately, we could affirm that the rate adverse reaction to drugs are often over estimated by both the families and the physicians. Therefore, children may be prone to loss of school days and inappropriate or sub-optimal treatments. However, the identification of a true adverse reaction to drugs allows adequate treatment and alert to further exposure to harmful drugs.
... Thus, e.g., the frequency of positive results of skin tests (i.e. confirmation of the classic IgE-mediated allergy) in patients with anamnestic data stating penicillin intolerance varies from 0 to 34% [19][20][21][22][23]. Among all ABD, penicillins cause allergic reactions most often; their frequency varies from 1 to 10% [24,25]. ...
Allergic reactions to antibiotics are a serious issue of pediatric practice and a difficult problem for pediatricians due to difficulties of diagnostics, interpretation of anamnestic data and subsequent selection of adequate antibacterial therapy. The review describes the main types of allergic reactions to the antibacterial drugs most widely used in children. Special attention is given to drug hypersensitivity development risk factors; clinical manifestations of allergy to antibiotics and peculiarities of allergic reactions to certain drugs are described. The article dwells upon clinical approaches and algorithms of managing patients with presumed intolerance to antibacterial drugs.
... Os vírus mais frequentemente associados a urticá- ria são o vírus Epstein-Barr, adenovírus, vírus influen- za, vírus sincicial respiratório, enterovírus, citomega- lovírus, parvovírus B19 e vírus da hepatite A e B. 6,9 Entre os agentes bacterianos, os mais mencionados são estreptococos, Mycoplasma pneumoniae e Helico- bacter pylori. Os parasitas mais comuns são Anisakis simplex, Giardia lamblia e Plasmodium falciparum. ...
Urticaria is a clinical entity shared by a heterogeneous group of diseases, and must be seen as a symptom and not a disease. The characteristic cutaneous lesions are erythematous papules or with a clear central zone and a peripheral erythema, pruriginous, that disappears with digital pressure and completely regresses in less than 24 hours. In some cases its accompanied by angioedema, although usually it occurs isolated. Urticaria may affect up to 25% of population in some moment of life. Acute urticaria (less than 6 weeks of duration), more frequent in children, is more prevalent than the chronic form. In cases that the etiology is identified, infections, foods and medications are the most frequent causes. Insect stings and systemic diseases are more rarely involved. In chronic urticaria, allergy IgE-mediated is rare. Complementary diagnostic exams must be criterious and supported by relevant clinical data; exhaustive analytic examinations must be avoided. Most episodes of urticaria are of short duration and spontaneous resolution. Acute urticaria has an average duration of 7 days; the chronic form has a variable evolution. Regarding the treatment, elimination of the causative agent is the ideal approach, but it isnt always possible. The first choice of symptomatic treatment are non sedative H1 antihistaminics, in higher dosage than the usually recommended. Some alternative therapeutics may be associated, but strong scientific evidence supporting their efficiency is lacking. Referral to a specialized consultation is important in some situations; some examples are allergy IgE-mediated or suspicion of systemic disease.
... A study of pediatric patients who were referred to an allergy clinic found that antibiotic-associated CADRs were reproducible with a drug rechallenge in only 8 of 62 patients. 12 Another study confirmed true drug allergies in only 4% of the patients referred to their clinic. 13 Because a known "allergy" is a contraindication for prescribing an associated drug, and possibly all drugs in the same class, a hasty diagnosis can unnecessarily limit therapeutic options, which can increase the risk of using medications that are more toxic, less effective, and more costly. ...
... 28 Studies have found some links between genetic variation in drug metabolism and CADRs. 12,13,120,121 ...
Cutaneous eruptions are a commonly reported adverse drug reaction. Cutaneous adverse drug reactions in the pediatric population have a significant impact on patients' current and future care options. A patient's recollection of having a "rash" when they took a medication as a child is a frequent reason for not prescribing a particular treatment. The quick detection and treatment of cutaneous adverse drug reactions, plus identification of the causative agent, are essential for preventing the progression of the reaction, preventing additional exposures, and ensuring the appropriate use of medications for both the current condition and others as the patient ages. The purpose of this review is to discuss a reasonable approach to recognition and initial management of cutaneous adverse drug reactions in children.
... These conclusions were supported by an investigation in children who developed a rash after antibiotic ingestion given to treat a URI (otitis media, sinusitis, or pharyngitis). 73 Each of the 86 patients was given the same antibiotic that caused the rash while they were well, with none developing a rash, leading the authors to conclude that the practice of complete avoidance of antibiotics associated with a rash may be unwarranted. ...
... Widely variable rates of true penicillin allergy based on skin testing have been reported among children and adults in the literature, ranging from 0% to 34%. 5,[7][8][9][10][11] We propose that this variation is likely due to differences in physician management of the initial clinical event that leads to a suspicion of drug allergy. When a suspected drug reaction occurs it is important for the physician to take a thorough history, perform a physical examination looking for any manifestations of a drug reaction, and document findings in the health record. ...
Penicillin allergy, commonly reported in children, leads to use of more expensive, broad-spectrum drugs. The results and effectiveness of a skin testing program for immediate hypersensitivity to penicillin in children were studied.
Children seen at the IWK Health Centre in Halifax between 1986 and 2000 with a history of suspected penicillin allergy were referred by their family physician or pediatrician. Two-stage skin testing (scratch, intradermal) of benzylpenicilloyl-polylysin and penicillin G sodium, with histamine and saline as positive and negative controls, was carried out. If the test results were negative, an oral challenge was conducted and the child observed for 60 minutes. If no adverse reaction was noted, a letter was sent to the referring physician and to Health Records at the IWK Health Centre, indicating that warning labels should be removed from the chart.
Of 72 children tested, 32% described their past cutaneous eruption as hives and 68% had other rashes; 96% of rashes were generalized. The mean age at the time of the suspected penicillin allergy was 4.4 years; it was 7.4 years at the time of testing. There was no positive response to the scratch testing, but 4% of children had a positive response to intradermal testing. No adverse responses to oral challenge were observed. Letters confirming negative status were not received in 4% (3 of 69) cases, resulting in ongoing avoidance of penicillins and falsely labelling of the child as penicillin allergic.
In this referral setting, true penicillin allergy was uncommon, suggesting that many children are incorrectly labelled as penicillin-allergic. Communication of test results to family and care providers and health records administration must be effective if testing is to affect prescribing behaviour.
... Parental or patient reports of drug allergies always overestimate the true frequency. For example, when children with reported allergies to penicillin are subjected to skin testing, a range of 0% to 34% will have an IgE-type reaction (16)(17)(18)(19)(20). A small number of children have allergies to multiple antibiotics (21); the etiology of this phenomenon is not clear. ...
... The interaction between viral infections and certain antibiotics can result in adverse events that appear to be specific to certain viruses, for example, cutaneous reactions to ampicillin in acute infectious mononucleosis and to sulphonamides in patients with HIV infection (22). Reactions may be caused by excipients and additives in the antibiotic preparation, or by a drug previously taken by the patient (19). Although frequently a cause of physician and parent anxiety, the incidence of allergic cross-reactions to cephalosporins in patients who are allergic to penicillin is less than 2% (4). ...
