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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
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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.

Peer review status:IN REVISION

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