Related Experiment Videos
Multiple antibiotic sensitivity in a pediatric population
M M Kamada1, F Twarog, D Y Leung
1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Abstract:
Multiple antibiotic sensitivity (MAS), a common but complex clinical problem, has not been reviewed in the pediatric population. We evaluated 120 children with a history of MAS. The offending antibiotics were beta lactam (186 adverse reactions), sulfonamide (86 adverse reactions), macrolide (32 adverse reactions), erythromycin/sulfisoxazole (26 adverse reactions), aminoglycoside (2 adverse reactions), and tetracycline (2 adverse reactions). Urticaria occurred in 183 reactions, followed by polymorphous rash (n = 71), angioedema (n = 19), erythema multiform (n = 9), bronchospasm (n = 8), arthralgia (n = 7), serum sickness (n = 4), and laryngeal edema (n = 3), the mean age for the first reaction was 3 years (range 1 month to 13 years). Adverse reaction to three classes of antibiotics were noted in 22 patients, and two patients were noted to have adverse reactions to four or more antibiotic classes. Skin tests (ST) were performed in 98 children using penicillin G, a commercial benzyl penicilloyl polylysine, a minor determinant mixture, and a beta lactam analog. Positive ST were noted in 26% (31/120) of the MAS patients. Children with a history of MAS are likely to have true IgE-mediated reactions as documented by positive immediate hypersensitivity reactions to penicillin and/or its minor determinants. Therefore, MAS patients should be carefully evaluated for antibiotic sensitivity and not be assumed to have sensitivity to drug formulation as a basis for MAS.
Insights
Multiple antibiotic sensitivity (MAS) in children often involves IgE-mediated reactions, particularly to beta-lactams. Skin tests can confirm hypersensitivity, guiding accurate diagnosis and management for pediatric antibiotic allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
- Dermatology
Background:
- Multiple antibiotic sensitivity (MAS) is a frequent clinical challenge, especially in children, but lacks comprehensive review.
- Understanding the patterns and mechanisms of MAS in pediatric populations is crucial for effective management.
Purpose of the Study:
- To investigate the characteristics of multiple antibiotic sensitivity in a cohort of 120 children.
- To identify common offending antibiotics, reaction types, and the role of IgE-mediated hypersensitivity.
Main Methods:
- Retrospective evaluation of 120 children with a history of MAS.
- Analysis of antibiotic classes involved, types of adverse reactions, and patient demographics.
- Performance of skin tests (ST) using penicillin G and related components in 98 children.
Main Results:
- Beta-lactams were the most frequent cause of adverse reactions (186), followed by sulfonamides (86).
- Urticaria was the most common reaction (183), followed by rash (71) and angioedema (19).
- Positive skin tests were observed in 26% of patients, indicating IgE-mediated hypersensitivity.
Conclusions:
- Pediatric MAS is frequently associated with true IgE-mediated hypersensitivity, particularly to penicillin.
- Skin testing is valuable for confirming antibiotic hypersensitivity in children with MAS.
- Accurate evaluation for specific antibiotic sensitivities is essential, rather than assuming generalized drug formulation sensitivity.