Short and extended provocation tests have similar negative predictive value in non-immediate hypersensitivity to beta-lactams in children

Introduction and objectives: Drug provocation tests (DPTs) are the gold-standard method to diagnose non-immediate hypersensitivity reactions (NIHSR) to beta-lactam antibiotics (BL) in children. Our aim was to compare the negative predictive value (NPV) of one-day (short) DPT versus 3-7 days (extended) DPT for the diagnosis of NIHSR to BL in paediatric age. A secondary aim was to compare confidence on drug re-exposure after short and extended negative DPTs. Methods: The occurrence of HSR on drug re-exposure and drug refusal after negative diagnostic DPTs were evaluated in children/adolescents with a history of NIHSR to BL using a questionnaire performed six months to ten years after DPT. Patients were divided into two groups according to the protocol performed: short DPT vs. extended DPT. Results: We enrolled 212 children and adolescents (86 females, 126 males, mean age at DPT 5.52 years, p25 = 3 years, p75 = 7.25 years): 69 tested with short DPT, and 143 with extended DPT. The NPV of both types of DPT together was 95.2%. The NPV of short DPT was 97.5% and the NPV of extended DPT was 93.8% (p = 0.419). After negative DPT, beta-lactams were refused by carers in 14.75% of the children requiring subsequent treatment, 6.98% in the short DPT group and 18.99% in the extended DPT group (p = 0.074). Conclusions: In our paediatric sample, prolonging drug administration did not increase the NPV of diagnostic DPT for NIHSR to BL or reduce drug refusal. Altogether, the data here reported suggest that, however intuitive, prolonging DPT is not beneficial in the parameters analysed

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Prevalence of self-reported drug hypersensitivity reactions among Lithuanian children and adults

Introduction and objectives: Drug hypersensitivity reactions (DHRs) are the adverse effects of drugs that, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. We aimed to assess the prevalence of self-reported DHRs among Lithuanian children and adults and to identify possible risk factors. Materials and methods: A cross-sectional survey of a population visiting their general practitioners in Vilnius and Kaunas regions of Lithuania was performed. Thirty-five questions on drug allergy symptoms, in addition, food, pollen allergy and family history were included. Results: 3222 (60.0%) children and 2148 (40.0%) adults were included in the study. 7.9% of children and 13.8% of adults reported a DHR for at least one drug (p < 0.001). 69.8% of children and 47.3% of adults, who indicated DHRs, had skin symptoms. Rate of anaphylaxis was similar in both groups (about 10%). 4.5% of children and 7.3% of adults had DHRs induced by antibiotics and this was the most implicated group of drugs. Significant self-reported risk factors for DHRs were family history of DHRs (OR = 6.007, 95%CI 4.756-7.587), pollen allergy (OR = 2.0, 95%CI 1.573-2.544), food allergy (OR = 1.92, 95%CI 1.505-2.448), female gender (OR = 1.439, 95% CI 1.187-1.744) and age (OR=1.017 in favour of adults, 95% CI 1.013-1.021). Conclusions: The prevalence of self-reported DHRs in Lithuania is higher among adults than children. Drug-induced skin reactions were the predominant symptom in both groups. Besides female gender and age, a positive family history of DHR and presence of pollen or food allergy may be associated with DHR

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Neuropsicologia e oncologia pediátrica: um diálogo em emergência / Neuropsychology and oncology: an emerging dialogue

Dados do INCA estimam que anualmente cerca de 11.530 casos de neoplasias são diagnosticados em crianças e adolescentes. O aumento do número de sobreviventes vem crescendo, junto com as sequelas cognitivas decorrentes da doença e de seu tratamento. Nesse sentido, o presente artigo discute acerca da pertinência do estabelecimento de diálogo entre a neuropsicologia e a oncologia. O artigo aborda os dois subtipos de câncer mais comuns na infância e adolescência: os tumores de fossa posterior e a leucemia linfoide aguda. A discussão será ilustrada com resultados oriundos de dois estudos distintos realizados em serviços públicos de referência no tratamento do câncer pediátrico na Região Nordeste do Brasil (AU)