The Frequency and Clinical Features of Hypersensitivity Reactions to Antiepileptic Drugs in Children: A Prospective Study

Publication date: Available online 6 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Hakan Guvenir, Emine Dibek Misirlioglu, Ersoy Civelek, Muge Toyran, Betul Buyuktiryaki, Tayfur Ginis, Murat Capanoglu, Esra Gurkas, Alev Guven, Can Naci Kocabas
BackgroundAntiepileptic drugs (AEDs) can cause hypersensitivity reactions during childhood. Studies report a wide clinical spectrum of reactions with AED use, ranging from a mild rash to severe cutaneous reactions.ObjectiveThe present study aims to determine the prevalence and clinical features of AED hypersensitivity reactions during childhood.MethodsPatients who were prescribed an AED for the first time in our hospital during November 2015 and November 2016 were followed and children who developed skin rash during this period were evaluated.ResultsTotally 570 patients were evaluated. The median age of the patients was 8.86 [(interquartile range (IQR): (4.2-13.7)] years, and 55.8% of patients (318/570) were male. Most frequently used AEDs were valproic acid (42%; n=285) and carbamazepine (20.4%; n=116). Hypersensitivity reactions against AEDs developed in 5.4% of patients. Of these patients 71% (n=29) had cutaneous drug reaction and 29% (n=9) had severe cutaneous drug reaction; 61.3% (n=19) were using aromatic type of AED, and the leading suspected AED was carbamazepine (45.2%). Comparison of patients who did and did not develop AED hypersensitivity showed that hypersensitivity was more frequent among patients who were younger than 12 years old, who used aromatic AED, or who used multiple AED. In addition, according to regression analysis results, aromatic AED use significantly increased the risk of AED hypersensitivity (p<0.001).ConclusionAlthough allergic reactions against antiepileptic drugs are rare, they are of significance as they can cause life-threatening severe cutaneous drug reactions. Therefore, patients receiving AEDs, especially aromatic AEDs, must be monitored closely.