ArticlePediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology2026
Clinical and behavioral determinants in pediatric non-immediate drug hypersensitivity: Low confirmation but persistent avoidance.
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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- Clinical and behavioral determinants in pediatric non-immediate drug hypersensitivity: Low confirmation but persistent avoidance.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026Article
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4 authors.
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Abstract
backgroundNon-immediate drug hypersensitivity reactions (DHRs) in children are frequently overdiagnosed, leading to unnecessary drug avoidance. Evidence regarding predictors of more extensive reactions, drug provocation test (DPT) outcomes, and re-exposure behavior and avoidance remains limited.
methodsThis retrospective cohort study included 161 children referred for suspected non-immediate-type DHRs. Clinical characteristics, reaction features, laboratory findings, and DPT outcomes were collected from medical records. Re-exposure behavior and avoidance were assessed at 6 and 12 months. Logistic regression was used to identify predictors of more extensive reactions, DPT outcomes, and avoidance of re-exposure.
resultsBeta-lactam antibiotics were the most frequently implicated drugs in 154 (95.7%) cases. Generalized cutaneous reactions occurred in 79 (49.1%) and were associated with male sex (OR: 2.70, 95% CI 1.31-5.56, p = .007), concomitant rhinitis/conjunctivitis (OR: 2.41, 1.02-5.71, p = .045), atopic dermatitis (OR: 2.55, 1.05-6.19, p = .038), and symptom onset after >3.5 days of treatment (OR: 3.21, 1.57-6.49, p = .001). DPT was positive in 9.3% of tested children, with no independent predictors of positivity. A mild maculopapular rash as the index reaction independently predicted a negative DPT result. (OR: 6.74, 1.83-24.83, p = .004). At 6 months, 40.7% avoided re-exposure despite clinical indication, associated with generalized urticaria as the index reaction (OR: 2.60, 1.00-6.72, p = .048) and having received treatment for the reaction (OR: 4.12, 1.08-15.73, p = .038). By 12 months, 86.5% of patients had reused the culprit drug.
conclusionMale sex, atopic comorbidities, and later-onset reactions were associated with an increased risk of more extensive non-immediate-type DHRs. Despite low DPT positivity and good re-exposure tolerance, drug avoidance remains frequent, particularly after treated or generalized reactions.
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