Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

Ital J Pediatr. 2020 Jan 10;46(1):5. doi: 10.1186/s13052-019-0753-4.


Background and objective: Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs.

Methods: The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines.

Results: Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs.

Conclusion: Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Keywords: Allergy tests; Drug hypersensitivity reaction; Epidemiology; Pediatrics.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Drug Hypersensitivity / epidemiology*
  • Female
  • Hospitals, Pediatric
  • Humans
  • Immunoglobulin E / blood
  • Infant
  • Italy / epidemiology
  • Male
  • Retrospective Studies
  • Skin Tests
  • Tertiary Healthcare


  • Immunoglobulin E