Non-β-Lactam Antibiotic Hypersensitivity Reactions

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Pharmacology
• Infectious Diseases

Background:

• Non-β-lactam antibiotics (NBLAs) are frequently prescribed to children.
• Data on NBLA hypersensitivity reactions and allergy evaluations in pediatric populations are limited.
• This study addresses the need for better understanding of NBLA allergy in children.

Purpose of the Study:

• To describe reported hypersensitivity reactions to NBLAs in children.
• To report the outcomes of allergy evaluations for suspected NBLA hypersensitivity.
• To assess the rate of successful delabeling of NBLA allergy in pediatric patients.

Main Methods:

• Retrospective analysis of children undergoing allergy evaluations for suspected NBLA hypersensitivity.
• Inclusion criteria: children with suspected NBLA allergy undergoing skin testing and/or oral challenge tests (OCT) between May 2011 and June 2018.
• Exclusion criteria: patients over 18 years or those not completing evaluation.

Main Results:

• 150 allergy evaluations for 15 different NBLAs were conducted in 141 children over 7 years.
• 18.0% of NBLA challenge tests were positive, with highest rates for trimethoprim-sulfamethoxazole (32.6%) and macrolides (10.4%).
• 80% of children with suspected NBLA allergy were successfully delabeled, with most positive challenges showing similar symptoms on repeat testing.

Conclusions:

• A significant proportion of children with suspected NBLA allergy can be safely delabeled.
• The median delay to allergy evaluation was 1.9 years, highlighting a need for timely access.
• Prompt allergy evaluations are essential to avoid unnecessary avoidance of first-line antibiotics.