Drug Allergy in children

Self or parent reported DRUG ALLERGY is very common and it is estimated that more than 15% of patients/parents report drug allergy.

What are True Drug Allergy Reactions?

True drug allergic or hypersensitivity reactions may result in very minor, limited reactions like urticaria/angioedema or more severe reactions, including anaphylaxis, which may be fatal. Serious allergic and anaphylactic reactions can occur when known drug allergens are prescribed, dispensed and administered to patients in hospitals and the community. This harm is preventable.

Antibiotic Allergy Labelling?

Conversely, there is a lot of overdiagnosis of drug allergy. Most children labelled as allergic to an antibiotic are actually not allergic to the antibiotic.

Data suggests that >90% of children labelled as allergic to antibiotic can actually tolerate it. True antibiotic allergy is considered to be less than 10%. Most commonly the antibiotic allergy labels are acquired because rashes reported by parents. Most children are labelled before 3 years of age and these labels are carried into adulthood.

What are the harms of False Antibiotic Allergy Labelling?

False Antibiotic Allergy Labelling results in use of alternative antibiotics which are costly, less effective, contribute to increase in drug resistance. Adverse drug labelling is more important in children with chronic diseases like Cystic Fibrosis etc.

What are the most common drugs leading to allergic reactions in children?

  • Most common allergic reactions are to penicillin and related antibiotics like cephalosporins
  • The other drug allergy reactions are due to NSAIDs (like ibuprofen etc), contrast media and anaesthesia drugs

How do we deal with a child with Suspected Drug Allergy?

A rational approach to a child with suspected drug allergy includes

  • Details on the drug reaction: when, type of reaction and what drugs were taken
  • Risk Assessment is done to plan a drug challenge
  • Drug Allergy if confirmed a suitable alternative to the offending drug is suggested

Pediatric Drug Challenge

The details of the drug challenge procedure are detailed under the section of Pediatric Drug Challenge