Les réactions « allergiques » aux médicaments anti-infectieux chez l'enfant (revue générale)

Seven to 15% of children report suspected allergic/hypersensitivity (HS) reactions to drugs, antibiotics especially, but studies based on clinical history, skin tests (ST) and drug challenge/provocation tests (DPT) have shown that only 10-15% of these children were truly allergic, except for the children reporting immediate and/or severe reactions. Diagnosis is usually based on a careful analysis of the clinical history, ST and DPT, but many authors currently recommend prolonged DPT with the suspected drugs as a first-line diagnostic test in non-immmediate and non-severe reactions because the diagnostic value of non-immediate-reading ST, the risk of a reaction during DPT, and, if such a reaction occurs, the risk of a severe reaction are low. Before the allergological work-up is performed, eviction of all drugs in the same and closely related classes (ie: penicillins and 1st generation cephalosporins in case of a reaction to amoxicillin) is recommended in children reporting immediate and/or anaphylactic reactions, because there is a high risk of cross-reactivity, except for macrolides. In mild to moderately severe non-immediate reactions, other drugs in the other classes of the same family can be prescribed safely because the risk of cross-reactivity is low. Most children reporting allergic-like reactions to several families or classes of antibiotics are not allergic to drugs. In those children, one may think to a possible allergic or non-allergic (“intolerance”) HS to other drugs, often associated with antibiotics (non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs especially).