D3.378 - Drug hypersensitivity in children in a frontline setting: interim results of a pilot epidemiological project

Drug hypersensitivity is a significant clinical challenge. Its epidemiological assessment depends on physician awareness, availability of registries, and access to diagnostic tools. Zaporizhzhya is a frontline city located approximately 40 km from the active combat zone, where research activities are limited by war-related population displacement and lack of funding. Nevertheless, digital technologies enabled initiation of a pilot project to assess suspected drug hypersensitivity in children.

An online questionnaire was developed using Google Forms and distributed to parents of school-aged children in Zaporizhzhya via school messenger groups, in collaboration with the city Departments of Health Care and Education. Data collection complied with Ukrainian legislation, and informed consent for anonymized data use was obtained. The questionnaire covered allergy history, suspected drug hypersensitivity reactions, culprit drug groups, reaction phenotype, previous tolerance to related drugs (antibiotics, non-steroidal anti-inflammatory drugs, local anesthetics), and prior diagnostic evaluation. Children requiring further assessment were identified and contacted. A standardized diagnostic protocol, including detailed questionnaires and informed consent, was developed. At this stage, a complete diagnostic pathway, including drug provocation tests, has been finalized for cephalosporin antibiotics.

A total of 2,479 questionnaires were analyzed. Among them, 503 children (20.3%) were identified as requiring further evaluation. Suspected reactions were most frequently reported to antibiotics (n=152), non-steroidal anti-inflammatory drugs (n=92), local anesthetics (n=49), antiviral drugs (n=51), monoclonal antibodies (n=2), and other medications, including topical antiseptics and mucolytics (n=157). Based on clinical characteristics, 255 children were selected for in-depth diagnostic assessment. To date, one complete diagnostic work-up, including an intravenous drug provocation test with ceftriaxone, has been performed, allowing exclusion of cephalosporin allergy in a child who had avoided this drug class for three years due to a false diagnosis.

This pilot project demonstrates the feasibility of organizing drug hypersensitivity diagnostics in a frontline, resource-limited setting. The project may serve as a basis for establishing a specialized Drug Allergy Diagnostic Center and contributes to improving awareness that not all adverse drug reactions are allergic and require drug avoidance