The RCPCH care pathway for children with drug allergies: an evidence and consensus based national approach

Abstract

This pathway demonstrates the spectrum of drug allergy is varied and may differ for young children compared with older children and adults. The authors highlight the paucity of evidence to support allergy testing for most drugs, in children, other than supervised incremental provocation tests (when indicated). Acute presentations require emergency health professionals to address underlying allergic issues, including recognition and avoidance of potential drug allergy triggers. Non-acute presentations may include multi-system symptoms which may have a broad differential diagnosis; this document signposts to the relevant partners in the RCPCH care pathway portfolio. Management combines a care package including a definitive diagnosis, initiating treatments and ongoing education.

Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement

“…The most comprehensive safety guideline on DPT is from the European Network for Drug Allergy (ENDA) [ 57 ]. Other guidelines are on the general aspect of the diagnosis and management of drug allergy [ 18 , 62 , 136 – 138 ].…”

A UK national survey of investigations for beta‐lactam hypersensitivity – heterogeneity in practice and a need for national guidelines – on behalf of British Society for Allergy and Clinical Immunology (BSACI)

“…The clinical importance of this is uncertain and there needs to be a balance between unnecessary skin testing and exposing children to excessive drug provocation testing. The Royal College of Paediatrics and Child Health (RCPCH) acknowledges that the evidence base for drug allergy testing in paediatric practice is small [12] and it is likely that separate guidelines for paediatrics will be devised. Reassuringly, no responders that saw paediatric cohorts experienced a systemic reaction to skin testing.…”

Drug hypersensitivity in children: report from the pediatric task force of theEAACIDrug Allergy Interest Group

“…Due to the paucity of reliable data, it is difficult to assess the real value of skin tests to drugs in children, because most publications reporting skin test results are older, have neither used actual recommended protocols, nor have included DPTs and have validated their results only against the clinical history. Recent reports showed that the evidence to date does not clearly lean in favor or against skin testing in children .…”