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Patch Testing in Paediatric Drug Hypersensitivity Reactions: Current Evidence and Clinical Implications.
Gabriele Simonetti1,2, Francesco Catamerò1,2, Giulia Liccioli2
1Department of Health Sciences, University of Florence, Florence, Italy.
Contact Dermatitis
|June 10, 2026
Summary
Patch testing (PT) is a safe tool for investigating pediatric drug hypersensitivity reactions (DHRs), especially severe cutaneous adverse reactions. Its diagnostic value varies by drug class, with lower sensitivity for antibiotics but higher rates for antiepileptic drugs.
Area of Science:
- Pediatric Allergy and Immunology
- Dermatology
- Clinical Pharmacology
Background:
- Drug hypersensitivity reactions (DHRs) are common and challenging to diagnose in children, often presenting with skin issues.
- Patch testing (PT) is established for delayed T-cell reactions in contact dermatitis, but its utility in pediatric DHRs is not well-defined.
Purpose of the Study:
- To evaluate the role and diagnostic yield of patch testing (PT) in diagnosing drug hypersensitivity reactions (DHRs) in pediatric patients.
- To assess the safety and effectiveness of PT in various clinical scenarios and drug classes within the pediatric population.
Main Methods:
- Review of available data on patch testing (PT) for pediatric drug hypersensitivity reactions (DHRs).
- Analysis of PT safety, diagnostic yield, and limitations across different drug classes (e.g., antibiotics, antiepileptics, NSAIDs) and clinical presentations.
- Consideration of methodological heterogeneity and pediatric-specific data limitations.
Main Results:
- Patch testing (PT) is generally safe for pediatric DHRs, particularly when drug provocation testing is contraindicated (e.g., severe cutaneous adverse reactions).
- Diagnostic yield varies significantly; sensitivity is low for beta-lactam and non-beta-lactam antibiotics but higher for antiepileptic drugs.
- Evidence for NSAIDs and paracetamol is limited, and methodological heterogeneity impacts interpretation.
Conclusions:
- Patch testing (PT) can be a valuable complementary tool for diagnosing pediatric DHRs, aiding in culprit drug identification and cross-reactivity assessment.
- Standardized protocols and prospective pediatric studies are needed to optimize the use of PT in this population.
- PT's utility is drug-class dependent, requiring careful integration with clinical history and other diagnostic methods.
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