Unmasking Beta-Lactam Allergies in Children: A Closer Look at Diagnosis and Risk Factors

Beta-lactam (BL) antibiotics are the most commonly implicated drugs in pediatric drug hypersensitivity reactions. However, most children with suspected BL allergy can safely tolerate these antibiotics after careful evaluation. The aim of this study was to evaluate the clinical characteristics, diagnostic work-up results, and risk factors associated with confirmed BL allergy in children referred with suspected BL hypersensitivity.

We retrospectively analyzed 158 children referred for suspected BL allergy between 2019 and 2025. Clinical and demographic data were collected from medical records. Diagnostic evaluation included skin testing and drug provocation testing. Patients were divided into two groups: those with confirmed BL allergy and those whose allergy label had been removed. Risk factors for BL allergy were compared between groups.

The cohort included 158 children (58% male; median age: 100.5 months; interquartile range [IQR]: 75-150.75). The median time from reaction to clinical evaluation was 7 months (IQR: 3-25). The most commonly implicated drug was amoxicillin/clavulanate (81.5%). Immediate reactions (IR) occurred in 47.8% of cases. BL allergy was confirmed in 36.7% of the cases. In the final logistic regression model, the type of hypersensitivity reaction (p = 0.001), severity of reaction (p = 0.001), and the presence of comorbidities (p = 0.008) remained significant predictors of confirmed drug allergy.

Given the low true allergy rate, accurate diagnosis and delabeling of suspected BL allergy in children is essential to avoid unnecessary antibiotic restriction.