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Antibiotic Allergy in Pediatrics
Allison Eaddy Norton1, Katherine Konvinse2, Elizabeth J Phillips3,2,4,5,6
1Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and allison.norton@vanderbilt.edu.
Insights
Most pediatric antibiotic allergy labels are inaccurate and lead to significant health risks and costs. Delabeling strategies, including skin testing, can safely re-evaluate children
Area of Science:
- Pediatric Allergy and Immunology
- Pharmacology
- Infectious Diseases
Background:
- Overlabeling of pediatric antibiotic allergy is a significant societal burden, with up to 10% of the US population labeled penicillin allergic.
- Most childhood antibiotic allergy labels persist into adulthood, leading to unnecessary healthcare risks, costs, and antibiotic resistance.
- Cutaneous symptoms in children are often misattributed to drug allergy, frequently being viral-induced or drug-virus interactions.
Purpose of the Study:
- To highlight the burden of pediatric antibiotic allergy overlabeling.
- To emphasize the need for effective antibiotic allergy delabeling strategies in children.
- To promote the use of diagnostic tools for accurate evaluation of antibiotic hypersensitivity.
Main Methods:
- Review of current literature on pediatric antibiotic allergy.
- Discussion of diagnostic tools such as skin testing and drug challenge.
- Exploration of antibiotic reactivity within drug classes and side-chain reactions.
Main Results:
- Most childhood antibiotic allergy labels are not indicative of true, long-lasting hypersensitivity.
- Awareness and emphasis on delabeling strategies are increasing, particularly in adults.
- Growing evidence supports the safe and effective use of skin testing and drug challenge in pediatric populations.
Conclusions:
- Accurate diagnosis and management of adverse drug reactions are crucial for pediatric primary care.
- Improved understanding of diagnostic tools can prevent unnecessary avoidance of essential antibiotics like penicillins.
- Antibiotic allergy delabeling in children can mitigate long-term healthcare risks and combat antibiotic resistance.
Abstract:
The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.
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