Allergy to beta-lactam antibiotics in children: Risk factors for a positive diagnostic work-up

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E. Dias de Castro
F. Carolino
L. Carneiro-Leão
J. Barbosa
L. Ribeiro
J.R. Cernadas


Drug allergy, Beta-lactam antibiotics, Children, Allergy diagnostic work-up, Risk factors


Background: Allergy to beta-lactam (L) antibiotics is highly reported in children, but rarely confirmed. Risk factors for a positive diagnostic work-up are scarce.

The primary aim was to characterize the cases of children with confirmed L allergy, investigating potential risk factors. Secondary aims were to assess the prevalence of allergy to L in this population and to confirm the safety of less extensive diagnostic protocols for milder reactions.

Methods: We reviewed the clinical data from all children evaluated in our Department for suspected L allergy, over a six-year period.

Results: Two hundred and twenty children (53% females) with a mean age of 6.5 ± 4.2 years were evaluated. Cutaneous manifestations were the most frequently reported (96.9%), mainly maculopapular exanthema (MPE). The reactions were non-immediate in 59.5% of the cases.

Only 23 children (10.5%) were diagnosed with allergy to L. The likelihood of L allergy was significantly higher in children with a  family history of drug allergy (p < 0.001) and in those with a smaller time period between the reaction and the study (p = 0.046). The probability of not confirming L allergy is greater in children reporting less severe reactions (p < 0.001) and MPE (p < 0.001).

We found the less extensive diagnostic protocol in milder reactions safe, since only 4.2% of the children presented a positive provocation test (similar reaction as the index reaction).

Conclusion: This study highlights family history of drug allergy as a risk factor for a positive diagnostic work-up. Larger series are required, particularly genetic studies to accurately determine future risk for L allergy in children.

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