Does Drug Allergy Workup in Children Satisfy Their Parents?

2021 ◽  
pp. 1-7
Author(s):  
Pinar Gokmirza Ozdemir ◽  
Velat Celik ◽  
Burcin Beken ◽  
İbrahim Arcanlı ◽  
Mehtap Yazicioglu
Keyword(s):  
Drug Allergy ◽  
Pediatric Patients ◽  
Time Interval ◽  
Procedure Time ◽  
Multiple Choice Questions ◽  
Pediatric Allergy ◽  
Provocation Tests ◽  
Median Time Interval ◽  
Drug Provocation Tests ◽  
Telephone Questionnaire

<b><i>Introduction:</i></b> Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming. The aim of this study was to assess parents’ perception of and satisfaction with their child’s drug allergy workup. Further, to evaluate parents’ tendency to use the tested drug following a negative DPT and the consequences of re-exposure. <b><i>Methods:</i></b> Parents of children that underwent drug allergy workup from January 2017 to August 2020 in the Pediatric Allergy Department of Trakya University Medical Faculty were included. Satisfaction levels were assessed via a telephone questionnaire (3 open-ended, 7 multiple-choice questions). Satisfaction was scored on a Likert scale (1: very unsatisfied and 5: very satisfied). <b><i>Results:</i></b> A total of 102 parents participated the study. Fifty-two (51%) of patients were male, and median age was 6.2 years and a median time interval between admission and test appointment of 1 month; 16.7% had a positive drug allergy workup, with 88.3% reporting being satisfied (56.9%) or very satisfied (31.4%) with the workup. Satisfaction levels were inversely related to the time between admission and test appointment (rho: −0.254, <i>p</i> = 0.01), with 8.2% reporting they did not use the tested drug when necessary despite a negative result. The tested drug was used by 35 individuals (41.1%), 33 (94.2%) tolerating without reaction. <b><i>Conclusion:</i></b> Most parents were satisfied with the workup, but levels were inversely related to the admission and procedure time interval. Drug allergy workup should be performed as soon as possible to relieve parents’ anxiety and achieve more patient satisfaction.

Negative predictive value of provocation tests for nonsteroidal anti-inflammatory drugs in children

2020 ◽  
Vol 41 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Ozge Yilmaz Topal ◽  
Kulhas C. Ilknur ◽  
Yagmur T. Irem ◽  
Toyran Muge ◽  
Civelek Ersoy ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Provocation Test ◽  
Allergy Clinic ◽  
Predictive Values ◽  
Pediatric Allergy ◽  
Provocation Tests ◽  
Drug Classes ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: After antibiotics, nonsteroidal anti-inflammatory drugs (NSAID) are one of the leading drug classes responsible for hypersensitivity reactions in children. The drug provocation test (DPT) is the criterion standard for diagnosis. Objective: The aim of the present study was to determine the negative predictive values (NPV) of DPTs with NSAIDs in pediatric patients and to evaluate their attitudes toward NSAID use after a negative DPT result. Methods: The study included all patients who had undergone DPTs between January 1, 2014, and December 31, 2018, in our pediatric allergy clinic for suspected NSAID hypersensitivity reaction and who had a negative result for the suspected agent. Those patients who could be contacted were asked whether the patient had used the same drug again since the DPT and, if so, whether he or she had a reaction. Patients who were reported to have had a reaction were invited to the clinic for reevaluation. Based on the findings from this retesting, the NPVs of the DPTs with NSAIDs were calculated. Results: During the 5-year study period, DPT results were negative for 230 suspected agents in 215 patients. Of these, 143 patients (66.5%) were able to be contacted. A total of 108 patients (75.5%) had used the tested NSAIDs at least once after the provocation test, and five patients (4.6%) reported a reaction on reexposure. Four of these patients declined reevaluation, one patient exhibited no reaction in a second DPT. Therefore, the NPV was calculated as 96.3% (94.3% for ibuprofen, and 100% for paracetamol). Conclusion: The NPVs of DPTs with NSAIDs, especially of paracetamol DPT, is high in children. This finding should reassure the parents of patients who may require NSAID therapy again.

Diagnostic value and safety of penicillin skin tests in children with immediate penicillin allergy

2020 ◽  
Vol 41 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Ozge Yilmaz Topal ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Diagnostic Value ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Provocation Tests ◽  
Test Kit ◽  
History Of ◽  
Drug Provocation Tests ◽  
Immediate Reactions

Background: The first-line method in the diagnosis of patients who describe an immediate reaction after penicillin intake is a skin test (ST) with penicillin reagents. Objectives: We aimed to determine the safety and diagnostic value of penicillin STs in the diagnosis of immediate reactions to penicillins in pediatric patients. Methods: The study included pediatric patients with suspected immediate reaction to penicillin who were subjected to STs by using a standard penicillin test kit as well as suspected penicillin and the drug provocation tests (DPT) with the suspected penicillin at our clinic. Results: A total of 191 patients (53.9% boys) with a median age of 6.83 years (interquartile range, 4.2‐12 years) were included in the study. The time from drug intake to the onset of reaction was ≤1 hour in 138 patients (72.3%) and 1 to 6 hours in 53 patients (27.7%). Penicillin allergy (PA) was confirmed by diagnostic tests in 36 of the 191 patients (18.8%). In multivariate logistic regression analysis, the history of both urticaria and angioedema (odds ratio [OR] 27.683 [95% confidence interval {CI}, 3.143‐243.837]; p = 0.003) and anaphylaxis (OR 56.246 [95% CI, 6.598‐479.489]; p < 0.001) were the main predictors of a PA diagnosis. Although ST results were positive in 23 patients (63.8%), 13 patients (26.2%) had positive DPT results despite negative ST results. The negative predictive value (NPV) of STs was calculated 92.2% (155/168). None of our patients experienced immediate or delayed systemic and/or local reactions in relation to the STs. Conclusion: A history of urticaria with angioedema and anaphylaxis were the main predictors of true PA in children with suspected immediate reactions. STs with penicillin reagents are safe for use in children. Although STs have a high NPV, DPT is the gold standard for diagnosis. DPTs should be performed as the final step of the diagnostic evaluation of PA in patients with negative ST results.

The evaluation of drug provocation tests in pediatric allergy clinic: A single center experience

2014 ◽  
Vol 35 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Emine Vezir ◽  
Mustafa Erkocoglu ◽  
Ersoy Civelek ◽  
Aysenur Kaya ◽  
Dilek Azkur ◽  
...  
Keyword(s):  
Allergy Clinic ◽  
Single Center ◽  
Pediatric Allergy ◽  
Single Center Experience ◽  
Provocation Tests ◽  
Drug Provocation Tests

Direct challenges for delabeling drug allergy in pediatric patients

2021 ◽  
Vol 147 (2) ◽  
pp. AB10
Author(s):  
Sara Concha ◽  
Josefina Castagnoli ◽  
Florencia Neumann ◽  
Arturo Borzutzky ◽  
Rodrigo Hoyos
Keyword(s):  
Drug Allergy ◽  
Pediatric Patients

scholarly journals Virtual Reality vs. Tablet Video as an Experiential Education Platform for Pediatric Patients Undergoing Chest Radiography: A Randomized Clinical Trial

2021 ◽  
Vol 10 (11) ◽  
pp. 2486
Author(s):  
Jung-Hee Ryu ◽  
Jin-Woo Park ◽  
Sang Il Choi ◽  
Ji Young Kim ◽  
Hyunju Lee ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Virtual Reality ◽  
Randomized Clinical Trial ◽  
Experiential Education ◽  
Chest Radiography ◽  
Pediatric Patients ◽  
Procedure Time ◽  
Parental Presence ◽  
Education Platform ◽  
Procedural Outcomes

Virtual reality (VR), which offers an immersive experience, has been implemented into the education of pediatric patients to reduce peri-procedural anxiety. This randomized clinical trial evaluated the effect of VR, compared with standard video, on reducing anxiety and distress in pediatric patients undergoing chest radiography. A total of 120 children aged 4 to 8 years with scheduled chest radiography appointments were randomized into either the tablet or the VR group. Children in the tablet group experienced chest radiography indirectly with a 3 min tablet video, whereas those in the VR group received the same content via a VR experience. The distress of children was measured using the Observational Scale of Behavioral Distress (OSBD) scale. Parental presence and procedural outcomes were also recorded. The number of less distressed children (OSBD score < 5) was significantly higher in the VR group than in the tablet group (49 [81.7%]) vs. 32 [53.3%]) (p = 0.001). The OSBD scores, the need for parental presence, the procedure time, and the number of repeated procedures were all lower in the VR group. The immersive VR experience appears to decrease the degree of anxiety in children and increase the efficiency of the procedures compared with the tablet video with the same content.

Evaluation of Clinical Properties and Diagnostic Test Results of Cephalosporin Allergy in Children

2021 ◽  
pp. 1-7
Author(s):  
Ozge Yilmaz Topal ◽  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Diagnostic Test ◽  
Pediatric Patients ◽  
Drug Hypersensitivity ◽  
Maculopapular Rash ◽  
Test Results ◽  
Pediatric Allergy ◽  
Fixed Drug ◽  
Drug Hypersensitivity Reactions ◽  
Immediate Reactions

Introduction: Beta-lactams (BLs) are one of the most frequent causes of drug hypersensitivity reactions (HRs), and cephalosporins are a widely used subclass of BLs, especially in children. The aim of this study was to evaluate the clinical features and diagnostic test results of pediatric patients evaluated for suspected cephalosporin allergy. Methods: This study included patients who presented to our pediatric allergy clinic with a history of reactions attributed to cephalosporins between January 1, 2011, and December 31, 2019, and whose diagnostic tests were completed for the diagnosis. Results: This study included 120 pediatric patients and 69 (57.5%) of them were girls. The median age was 38.63 (interquartile range 10.5–85.7) months. Reactions occurring within 1 h of drug intake were reported in 33 patients (27.5%). Reactions were maculopapular rash in 55 (45.8%) patients, urticaria and/or angioedema in 49 (40.8%), anaphylaxis in 11 (9.2%), severe cutaneous drug reaction in 4 (3.3%), and fixed drug reaction in 1 patient (0.83%). The most frequently suspected agent was cefixime in 41 patients (34.2%). In total, 30 (25%) patients were diagnosed as having cephalosporin hypersensitivity. Confirmation of HRs was also significantly more frequent among patients who were older (p: 0.000), who had taken the drug parenterally (p: 0.000) and with immediate reactions (p: 0.000). Conclusion: Cephalosporin allergy has been confirmed in approximately one-fourth of the patients evaluated for suspected cephalosporin allergy. Confirmation of HRs was significantly more common among patients who were older, had immediate reactions, and had taken the drug parenterally.

Abstract 13248: The Impact of Instructions for Covering the Mouth and the Nose on Dispatch-Assisted Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hidetada Fukushima ◽  
Hideki Asai ◽  
Koji Yamamoto ◽  
Yasuyuki Kawai
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Median Time ◽  
Chest Compression ◽  
Fire Department ◽  
Emergency Call ◽  
Time Interval ◽  
Time Intervals ◽  
Median Time Interval ◽  
Study Results ◽  
The Impact

Introduction: Under the SARS-CoV-2 pandemic, rescuers are recommended to cover their mouth and nose with a facemask or a cloth as well as victim’s mouth and nose when performing cardiopulmonary resuscitation (CPR). However, its impact on dispatch-assisted CPR (DACPR) has not been investigated well. Hypothesis: DACPR including the instruction for covering the rescuer’s and the victim’s mouth and nose can significantly delay the start of the first chest compression. Methods: We retrospectively analyzed DACPR records of the Nara Wide Area Fire Department, covering population of 853,000/3361km 2 , in Japan. We investigated the key time intervals of 505 DACPR records between May 2020 and March 2021. We also compared the results to that of the same period in 2019 (535 records). Results: Dispatchers failed to provide mask instruction in 322 cases (63.8%). The median time interval from the emergency call and the start of CPR instruction was longer in 2020 (197 seconds vs 190 seconds, p=0.641). The time to the first chest compression was also delayed in 2020 (264 seconds vs 246 seconds, p=0.015). Among the cases that dispatchers successfully provided mask instruction (183 cases, 36.2%), median time intervals to the start of instruction and the first chest compression were relatively faster than cases without mask instruction (177 seconds vs 211 seconds and 254 seconds vs 269.5 seconds, respectively). Conclusions: Dispatchers failed to provide mask instruction in the majority of CA cases. However, our study results indicate that the impact of mask instruction on DACPR can be minor in terms of immediate CPR provision.

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