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Arzneimittelüberempfindlichkeit im Kindes- und Jugendalter

Klinische Symptome und Diagnostik häufiger Krankheitsbilder

Drug hypersensitivity in childhood and adolescence

Clinical symptoms and diagnostics of frequent disease patterns

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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Bei bis zu 10 % der pädiatrischen Patienten ergibt sich aufgrund elterlicher Angaben der Verdacht auf eine Arzneimittelüberempfindlichkeit. Diese kann sich klinisch einerseits als Sofortreaktion mit Urtikaria, Angioödemen oder Anaphylaxie äußern. Andererseits sind klinisch heterogene Spätreaktionen möglich, die von häufigen, milden Exanthemen („benign rashes“) bis zu sehr seltenen, schweren Arzneimittelreaktionen wie der toxischen epidermalen Nekrolyse reichen. Als häufigste Auslöser werden Betalactamantibiotika, nichtsteroidale Antirheumatika und Nichtbetalactamantibiotika vermutet. Allerdings lässt sich eine Überempfindlichkeit gegen das inkriminierte Arzneimittel in über 90 % der Verdachtsfälle ausschließen. Hierfür sind die eingehende Anamnese und die konsequente kinderallergologische Evaluation erforderlich. Validierte In-vitro-Untersuchungsmethoden stehen nur in geringem Maß zur Verfügung, während standardisierte Hauttestungen häufig eine niedrige Sensitivität aufweisen. Als diagnostischer Goldstandard gilt daher die titrierte, orale Provokationstestung mit dem vermuteten Auslöser oder einem potenziell kreuzreaktiven Ausweichpräparat.

Abstract

Parental suspicion of drug hypersensitivity is encountered in up to 10% of pediatric patients. Immediate hypersensitivity reactions consist of acute urticaria, angioedema and anaphylaxis; however, delayed reactions are also possible and range from mild benign rashes to rare severe drug reactions, such as toxic epidermal necrolysis. Beta-lactam antibiotics, non-steroidal anti-inflammatory drugs and non-beta-lactam antibiotics are the most frequently reported trigger agents; however, in over 90% of cases drug hypersensitivity can be ruled out by a detailed medical history and a thorough allergological work-up. In vitro tests are still insufficiently validated, while standardized skin tests are frequently limited by a low diagnostic sensitivity. Therefore, titrated oral provocation tests with the suspected trigger drug or potentially cross-reactive, alternative substances remain the diagnostic gold standard.

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Authors and Affiliations

  1. Abteilung für Pädiatrie, St. Marien-Hospital, Robert-Koch-Str.1, 53115, Bonn, Deutschland

    L. Lange &  S. Gernert

  2. Abteilung HNO-Heilkunde, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland

    C. Rose-Diekmann

  3. Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland

    A. Arens &  H. Ott

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  1. L. Lange
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  4. A. Arens
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  5. H. Ott
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Correspondence to L. Lange or H. Ott.

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Interessenkonflikt

L. Lange, S. Gernert, C. Rose-Diekmann, A. Arens und H. Ott geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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G. Hansen, Hannover

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Lange, L., Gernert, S., Rose-Diekmann, C. et al. Arzneimittelüberempfindlichkeit im Kindes- und Jugendalter. Monatsschr Kinderheilkd 165, 131–138 (2017). https://doi.org/10.1007/s00112-016-0223-7

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  • DOI: https://doi.org/10.1007/s00112-016-0223-7

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