What is new in beta‐lactam allergy in children?

Abstract

This review highlights the novelties in understanding the underlying immunologic mechanisms of drug hypersensitivity reactions (DHRs) with special reference to beta‐lactams (BLs) in the pediatric population, as well as tiny changes in clinical classification and diagnosis of DHRs, in the last couple of years. BLs are still the most commonly prescribed and used antibiotics in children. Viral infections are very often in children, and they can provoke skin rashes which are difficult to differentiate from DHRs. The majority of children are incorrectly labeled as “allergic.” Therefore, allergy to BLs in children is overdiagnosed. These children often receive suboptimal treatment with second‐line broad‐spectrum antibiotics, which are less effective, more costly, and associated with an increased risk of antibiotic‐resistant infections. This prolongs hospitalization and thus more uses health care. The correct diagnosis of BL allergy in children is still an important and hot topic. This review has outlined the need for correct diagnosis of BL allergy in children and all the controversies encountered by pediatricians and pediatric allergists. It is also necessary to change the paradigm.

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

“…Urticaria is the most common manifestation of immediate drug reactions (IRs) and usually appears within 1 hour after drug intake. The majority of IRs are mediated by IgE antibodies, but also can be mediated by COX‐1 inhibition or by MRGPRX2 (Mas‐related G protein–coupled receptor member X2), which depends on the type of drug that induced them 31 . Maculopapular exanthems (MPE) are the most common manifestation of non‐immediate drug reactions (NIRs).…”

“…Maculopapular exanthems (MPE) are the most common manifestation of non‐immediate drug reactions (NIRs). They primarily appear with erythematous macules and infiltrated papules, which often involve trunk and the proximal extremities in a symmetric distribution 4,31,32 . MPE appear mostly 7‐12 days of treatment, but not rarely after therapy was already stopped.…”

“…In AGEP, the exanthema is pustular and accompanied by fever and oedema. It may start on day 3 or 5 4,31 …”

Risk factors for bronchiolitis and asthma, and COVID‐19 symptoms in young children

“…In the first review article, Marina Atanaskovic Markovic, PAI Associate Editor for drug allergies, addresses key issues in this area. 1 In particular, she examines the overdiagnosis of beta-lactam allergy in young children with benign rashes, and the practical implications of unnecessary drug avoidance.Studies addressing this problem have been previously published in PAI. 2,3 In the second review, Foong and Santos comment on the difficult task of assessing tolerance development in food allergic children with the help of biomarkers.…”

“…This issue opens with two educational articles destined to update the readers on current drug allergy and food allergy issues. In the first review article, Marina Atanaskovic Markovic, PAI Associate Editor for drug allergies, addresses key issues in this area 1 . In particular, she examines the overdiagnosis of beta‐lactam allergy in young children with benign rashes, and the practical implications of unnecessary drug avoidance.…”