Teste de provocação oral descarta alergia aos fármacos
Oral challenge test rules out drug allergy
Cíntia de Matos Rodrigues da Silva; Débora Carla Chong-Silva; Carlos Antônio Riedi; Herberto Jose Chong-Neto; Nelson Augusto Rosario-Filho
Resumo
O objetivo deste estudo foi avaliar a utilidade do teste de provocação oral (TPO) em pacientes encaminhados para investigação de reações alérgicas a medicamentos. Foi realizado um estudo analítico, transversal, com coleta de dados de pacientes de 0 a 14 anos, com história de reação adversa a medicamentos no período entre junho de 2017 a junho de 2019. Os pacientes foram submetidos aos testes cutâneos alérgicos por puntura (TCA), e na sequência, TPO com os medicamentos suspeitos. Os TPO foram abertos, e se o paciente apresentasse manifestação clínica compatível, o teste era interrompido e considerado positivo. Foram avaliadas 38 reações com fármacos orais. Dentre os 36 pacientes submetidos aos TPO, 23 (63,8%) eram do sexo masculino, média de idade de 5,7 anos; 32 (88,8%) tinham história de atopia, e 13 (36,1%) apresentaram teste cutâneo positivo para aeroalérgenos. Todos (n = 38) relataram sinais e sintomas cutâneos, 9 (25%) com sintomas respiratórios, 2 (5,5%) com sintomas gastrointestinais e 1 (2,7%) com outros sintomas. Todos os TCA para os fármacos avaliados foram negativos. Os TPO foram realizados com: antibióticos em 21 (55,2%), 16 (42,1%) com analgésicos e anti-inflamatórios, e 1 com prednisona (2,6%). Dentre os TPO, somente 1 (2,6%) foi positivo ao ibuprofeno. Concluiu-se que o teste de provocação oral a fármacos teve a finalidade de excluir, mais do que confirmar alergia, o que reforça a importância da confirmação, uma vez que a prevalência de alergia medicamentosa confirmada é baixa, sobretudo em crianças.
Palavras-chave
Abstract
The aim of this study was to evaluate the usefulness of the oral challenge test (OCT) in patients referred for investigation of allergic drug reactions. This was a cross-sectional analytical study with data collected from patients aged 0 to 14 years with a history of adverse drug reactions from June 2017 to June 2019. The skin prick test (SPT) and OCT were performed with the suspected drugs. Open OCTs were used and, if the patient had a compatible clinical manifestation, the test was interrupted and considered positive. Thirty-eight reactions to oral drugs were evaluated. Of 36 patients subjected to OCT, 23 (63.8%) were male, with a mean age of 5.7 years, 32 (88.8%) had a history of atopy, and 13 (36.1%) were SPT-positive for aeroallergens. All 38 patients reported cutaneous signs and symptoms, 9 (25%) had respiratory symptoms, 2 (5.5%) had gastrointestinal symptoms, and 1 (2.7%) had other symptoms. All SPTs were negative for the evaluated drugs. OCTs were performed with antibiotics in 21 (55.2%), with analgesics and anti-inflammatory drugs in 16 (42.1%), and with prednisone in 1 (2.6%). Only 1 (2.6%) OCT was positive for ibuprofen. It was concluded that the OCT was intended to rule out rather than to confirm drug allergy, which reinforces the importance of confirmation, since the prevalence of confirmed drug allergy is low, especially in children.
Keywords
References
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Submitted date:
08/28/2019
Accepted date:
09/05/2019
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