Non-β-Lactam Antibiotic Hypersensitivity Reactions

Pediatrics. 2020 Jan;145(1):e20192256. doi: 10.1542/peds.2019-2256. Epub 2019 Dec 3.


Objectives: Antibiotics are among the most common prescriptions in children, and non-β-lactam antibiotics (NBLAs) account for almost half of those prescribed in Australian pediatric hospitals. Despite this, data on NBLA hypersensitivity in children are limited. This study describes reported hypersensitivity reactions to NBLAs in children and the results of allergy evaluation.

Methods: Children with a suspected NBLA allergy who had skin testing and/or an intravenous or oral challenge test (OCT) between May 2011 and June 2018 were included. Patients were excluded if they were >18 years old or did not complete the allergy evaluation for any reason other than allergic reaction.

Results: Over the 7-year study period, 141 children had 150 allergy evaluations of 15 different NBLAs. The median time from the initial reported reaction to allergy evaluation was 1.9 (range 0.1-14.9) years. Overall, 27 of the 150 (18.0%) challenge tests to NBLAs had positive results, with the rate of positive OCT results being highest for trimethoprim-sulfamethoxazole (15 of 46; 32.6%) and macrolides (8 of 77; 10.4%). Although 4 children reported initial anaphylactic reactions, no patients had severe symptoms on rechallenge or required adrenaline. Of the challenges that had positive results, the majority of children (23 of 27; 85.2%) had symptoms on repeat challenge similar to those that were initially reported.

Conclusions: Overall, 8 of 10 children with NBLA allergy could be delabeled. On average, patients waited 1.9 years to be rechallenged. Timely access to allergy evaluation to delabel these patients is needed to preserve first-line antibiotics.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / adverse effects*
  • Child
  • Child, Preschool
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / epidemiology
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Macrolides / adverse effects
  • Male
  • Retrospective Studies
  • Skin Tests
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects
  • Victoria / epidemiology


  • Anti-Bacterial Agents
  • Macrolides
  • Trimethoprim, Sulfamethoxazole Drug Combination