Testes cutâneos no manejo das suspeitas de reações de hipersensibilidade a antibacterianos: uma revisão integrativa

Abstract

Hypersensitivity reactions are frequently reported in the pediatric public, with antibiotics and anti-inflammatory drugs being the classes of drugs most commonly reported to cause reactions. The physiological and pharmacokinetic variations in this age group make children more prone to the harmful effects of drugs, making this public require particular care. Faced with the few data available in the literature regarding hypersensitivity reactions in children, studies that can synthesize the existing knowledge to help possible future applications are necessary. This review aimed to describe the management of Hypersensitivity Reactions to antibacterials in the pediatric population and the use of skin tests in the diagnostic protocol. An integrative literature review of quantitative descriptive type was performed. After applying the eligibility criteria seventeen articles were selected. The β-lactam antibiotics were the most reported in the involvement of suspected hypersensitivity reactions to drugs, with penicillins and cephalosporins being the most cited. The reactions were commonly reported with symptoms such as urticaria, angioedema, maculopapular eruptions, pruritus, and erythema. Studies have shown that a considerable amount of suspected hypersensitivity reactions to drugs in children are not properly investigated under existing protocols that include assessment of clinical history, skin tests, provocation tests, and laboratory tests. Currently, there are still controversies about the prior use of skin tests before the provocation tests, considered the gold standard, especially with regard to its usefulness for diagnosing non-immediate hypersensitivity reactions. However, studies evaluating the use of skin tests using major and minor determinants of benzylpenicillin have shown to be effective as part of the diagnostic protocol, with a good negative predictive value. These are easy tests to perform, low cost and good reproducibility, besides being tests more accepted by children, and can serve as the first step of the protocol.