Drug and Antibiotic Allergies in Children: Clinical Observations and Risk Factors

Pediatric antibiotic and drug allergies are a major challenge for clinicians because of the difficulty in properly delineating a true immunologic reaction from an incidental allergic (non-allergic) adverse reaction. Misdiagnosing children as allergic to drugs can result in unnecessary restriction of first-line antibiotics, the use of broad-spectrum drugs and high healthcare costs, and is a driver of antimicrobial resistance. This was a clinical observation study conducted to assess children with suspected allergies to antibiotics and drugs by detailed medical history, skin test, and controlled drug provocation procedures. Results showed that although the number of reactions where allergies were reported was high, the number of confirmed immunologically mediated allergies was significantly lower. Factors like younger age, family history of allergy and concomitant atopic conditions were associated with increased probability of true drug hypersensitivity. These findings make it especially important to have a structured diagnostic evaluation and to make sure to carefully risk-stratify, accurately diagnose and, where applicable, delabel children who have been wrongly labelled as allergic. The implementation of evidence-based assessment strategies can help improve patient outcomes and optimise the use of antibiotics as well as reduce unnecessary interventions in pediatric populations.