Drug Hypersensitivity Reactions in Children: Are there factors associated with severity?

Drug hypersensitivity reactions (DHR) are a public health problem, but there are few studies in Brazilian pediatric population. This study analyzes and describes potential factors associated with severity of DHR in children. Retrospective data analysis of 235 patients under 18 years old, evaluated in 8 specialized centers in Brazil, from 2009 to April 2018. Patients with a probable or confirmed diagnosis of DHR were included. Patients were classified according to characteristics of the reaction in non-severe (only cutaneous manifestation), and severe (cutaneous manifestation and involvement of other organs or systems). A 5% level of significance was established. The majority of patients (235/262) had a probable or confirmed diagnosis of DHR, and in 39% the reactions were considered severe. Severity was significantly associated with an atopic background for patients presenting immediate reactions. Severe reactions were observed more frequently in older children (≥6 years). Fever or infectious disease was present in 59% of children at the time of reaction, and in 39% of them, the reaction was severe. NSAIDs were reported as the culprit drug in 59% of cases and beta-lactam antibiotics in 32%, but no drug class association with severity was observed. There were no significant differences in severity considering patient’s gender and family history of DHR. Atopic children and patients older than 6 was associated showed a higher risk for severe DHR. Co-factors as infections and fever may also be involved in severity and more extensive studies would be useful to determine other factors.