An EAACI Task Force report on allergy to beta-lactams in children: Clinical entities and diagnostic procedures

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Immunology
• Pharmacology

Background:

• Beta-lactam (BL) allergy is frequently suspected in children, posing a significant public health concern impacting patient health and healthcare costs.
• A substantial proportion of suspected BL reactions are not confirmed upon comprehensive allergic workup.
• Recent research has intensified the investigation into the diagnostic accuracy of available allergy tests for BL hypersensitivity.

Purpose of the Study:

• To review and discuss the diagnostic strategies for various forms of beta-lactam allergy in pediatric populations.
• To address the ongoing debate regarding the optimal allergic workup for immediate reactions to BL.
• To provide insights into managing severe cutaneous adverse drug reactions in children.

Main Methods:

• Literature review focusing on the most relevant studies concerning the diagnosis of beta-lactam allergy in children.
• Analysis of current diagnostic guidelines and emerging research findings.
• Discussion of diagnostic test utility, including skin tests and drug provocation tests.

Main Results:

• It is increasingly accepted that skin testing can be omitted before drug provocation tests in children with benign, non-immediate BL reactions.
• A consensus on the optimal diagnostic pathway for benign immediate reactions to BL in children is still under development.
• Management of severe cutaneous adverse drug reactions related to BL remains challenging.

Conclusions:

• Diagnostic approaches for pediatric beta-lactam allergy have evolved, particularly for non-immediate reactions.
• Further research and consensus are needed to define the best diagnostic workup for immediate BL reactions in children.
• Effective management strategies for severe BL-induced cutaneous reactions require continued investigation.