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Allergy to antibiotics in children: an overestimated problem
Susanna Esposito1, Luca Castellazzi1, Claudia Tagliabue1
1Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
Insights
Antibiotic allergy is often overdiagnosed in children, leading to unnecessary avoidance of crucial narrow-spectrum antibiotics. Accurate allergy diagnosis requires comprehensive evaluation beyond clinical history to ensure appropriate antibiotic use.
Area of Science:
- Pediatric Pharmacology
- Clinical Immunology
- Infectious Diseases
Background:
- Antibiotics are frequently prescribed for children, with adverse events, including allergic reactions, occurring in up to 10% of cases.
- Antibiotic allergy is commonly overdiagnosed in pediatric populations due to reliance on clinical history without thorough allergy work-ups.
- This overdiagnosis can lead to the inappropriate avoidance of essential narrow-spectrum antibiotics.
Purpose of the Study:
- To critically evaluate the actual prevalence and significance of antibiotic allergy in children.
- To guide physicians in establishing appropriate diagnostic allergy work-ups for suspected antibiotic allergies.
- To promote more judicious and effective antibiotic therapy in pediatric patients.
Main Methods:
- Literature analysis focusing on the diagnosis and management of antibiotic allergy in children.
- Review of diagnostic approaches, including clinical history, laboratory tests, in vitro tests, and drug provocation tests.
- Assessment of the current diagnostic framework for both beta-lactam and non-beta-lactam antibiotics in pediatric populations.
Main Results:
- Clinical history alone is insufficient for accurate antibiotic allergy diagnosis in children, leading to overdiagnosis.
- The diagnostic work-up for beta-lactam antibiotic allergy is well-established, but limited data exists for non-beta-lactam allergies in children.
- Improper diagnosis results in children being unnecessarily restricted from beneficial narrow-spectrum antibiotics.
Conclusions:
- Accurate diagnosis of antibiotic allergy in children is crucial for appropriate antibiotic selection and to prevent unnecessary drug avoidance.
- Physicians need enhanced knowledge to implement structured allergy work-ups for a precise determination of drug allergy.
- Improved diagnostic strategies will optimize antibiotic use and patient outcomes in pediatrics.
Abstract:
Antibiotics are the most prescribed drugs for children, and a relevant number of prescriptions are associated with the emergence of adverse events. Allergic reactions are the most frequently reported adverse events, with an incidence of up to 10% of all prescriptions. However, literature analysis has shown that allergy to antibiotics is generally overdiagnosed in children because in most cases the diagnosis is based only on the clinical history without a full allergy work-up. Consequently, children are often improperly deprived of narrow-spectrum antibiotics because of a suspected allergy to these drugs. β-Lactams, mainly penicillins, are more frequently involved as a cause of allergy to antibiotics, although allergic problems are reported for most of the antibiotic classes. Accurate diagnosis is essential for a precise definition of determination of allergy to a given drug. Diagnosis has to be based on history, laboratory tests and, when possible, on in vitro and drug provocation tests. Unfortunately, the allergological work-up is well structured only for β-lactam antibiotics, whereas for non-β-lactams few studies are available, with very limited experience in children. The main aim of this paper is to discuss the real relevance of allergy to antibiotics in children in order to provide physicians with the knowledge needed to establish an appropriate diagnostic allergy work-up and to make better use of antibiotic therapy.
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