Breast-feeding may protect against drug reactions

OB/GYN News, Oct 15, 2004 by Timothy F. Kirn

VICTORIA, B.C. -- A prospective study of cutaneous drug reactions in hospitalized children suggests that children who are not breast-fed may have a greater risk of a drug reaction, Dr. Danielle Marcoux reported during the annual conference of the Canadian Dermatology Association.

The study found that the majority of these drug reactions were related to antibiotics and that morbilliform and maculopapular eruptions were the most common pattern observed.

While these two major findings are not surprising, few data exist on the epidemiology of cutaneous drug reactions in the pediatric population, said Dr. Marcoux of Sainte-Justine Hospital in Montreal.

The relationship between the reactions and breast-feeding has never been observed before and therefore cannot really be explained, said Dr. Marcoux, also of the University of Montreal. Moreover, perhaps because the study did not have a lot of cases, the decreased risk was small--less than twice the risk compared with the study's matched controls--and may not be certain.

The study collected cases of cutaneous drug reactions that occurred in Sainte-Justine Hospital between November 1999 and May 2003. Researchers identified 68 cases, of which 38 cases were matched to controls with similar admission dates and drug exposure.

Forty-six percent of the 68 cases occurred in children less than 1 year of age; however, when the investigators controlled for the fact that more younger children are admitted to the hospital, they found that the incidence actually increased with age, Dr. Marcoux said. The overall incidence was 0.7%. More than 90% of the cases had been admitted for an infectious disease, and two-thirds of the patients were male.

Reactions most commonly occurred with ampicillin, which was the culprit in 25% of the cases.

Other factors identified as potential risk factors for a cutaneous drug reaction were advanced maternal age and atopy.

BY TIMOTHY F. KIRN

Sacramento Bureau