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Oral drug challenge in drug hypersensivity reactions and its safety

Lorena Stella,Joana Soares,Adriana Ferreira,Fátima Praça,Jorge Romariz,Herculano Costa,Cludia Pedrosa.

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Introduction: Drug allergy is a common suspicion in pediatric age, although it is rarely confirmed. Considering its relevance in therapeutic decisions, the definitive diagnosis is important. The oral drug challenge (ODC) has a significant role both to confirm the diagnosis and to find safe alternative treatment options. Objectives: Characterize a pediatric population submitted to ODC in a level III hospital and evaluate the safety and need of a venous catheter. Materials and methods: Retrospective study that includes all oral drug challenge performed between January 2018 and December 2020, in patients younger than 18 years. Results: 186 ODC were performed during the study period, 85.5% were performed either to confirm or exclude the diagnosis and the remaining 14.5% were designed to choose a safe alternative regimen. The median age was 5 years. Personal history of atopy was positive in 24.3% of patients. Amoxicillin was the tested drug in 42.5% of the sample and amoxicillin associated with clavulanic acid in 22%. In 38% of cases the manifestations appeared within the first 24 hours. There were 2.1% (n=4) positive ODC and the drugs were amoxicillin (2 cases), paracetamol and ibuprofen. Conclusions: Alergy to drugs is rare in pediatric age, but its suspicion is common. Considering its relevance in therapeutic decisions, it is important to refer all suspected cases to diagnostic clarification. In our sample there was no record of any serious reaction, namely anaphylaxis, requiring iv medication. The oral drug challenge has an essential role in confirming or excluding hypersensitivity and is a safe procedure.

Key words: Allergy; drugs; hypersensitivity; oral challenge; safety

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