ArticlePediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology2026
Direct single dose mass delabelling of antibiotic allergy in pediatrics.
Article in Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Direct single dose mass delabelling of antibiotic allergy in pediatrics.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
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12 authors.
Funding
Abstract
backgroundUnsubstantiated antibiotic allergy labels affect between 8% and 25% of the population worldwide. Current risk stratification tools, derived from adult data, are not validated for children. A simplified, multi-patient protocol with minimal exclusion criteria is required to tackle the scale of this public health issue.
methodsPatients with possible antibiotic allergy were recruited from the Children's Health Ireland (CHI) allergy waiting list. Exclusion criteria were a serum sickness like reaction (SSLR), severe cutaneous adverse reaction (SCARs), anaphylaxis, or non-allergic symptoms. No prior allergy testing was performed. Dosing was direct single observed dosing in dedicated mass delabelling clinics, followed by a two-day home antibiotic course.
resultsConsenting patients (n = 162) were seen over 6 clinics with gradually increasing clinic sizes (Range 18 to 62, average 23). One patient only was excluded based on the severity of their index event. Average age was 7 years, n = 90/162 (55.6%) were female. Most were avoiding amoxicillin, n = 137/162 (84.6%). Negative challenge rates were similar to previous studies, n = 150/162 (92.6%), 3 had immediate reactions and 9 delayed (all non-severe). Patients retrospectively underwent risk stratification according to the 2024 EAACI position paper, high risk n = 38/162 (23.5%), intermediate risk n = 74/162 (45.7%) and low risk n = 50/162 (30.9%). Those deemed high risk were no more likely to have a positive challenge than those deemed low/intermediate risk (n = 2/38, 5.3% vs. n = 10/124, 8.1%, p = .56).
conclusionAntibiotic allergy delabelling in pediatrics is low risk and can be done safely in high patient load without prior allergy testing. Current risk stratification tools are not suitable for pediatric-specific models of care.
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