AUTHOR=Sáenz de Santa María R. , Bogas G. , Labella M. , Ariza A. , Salas M. , Doña I. , Torres M. J. 

TITLE=Approach for delabeling beta-lactam allergy in children

JOURNAL=Frontiers in Allergy

VOLUME=Volume 4 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/allergy/articles/10.3389/falgy.2023.1298335

DOI=10.3389/falgy.2023.1298335

ISSN=2673-6101

ABSTRACT=A considerable number of children treated with betalactams (BLs) develop delayed skin rashes during the course of treatment with these antibiotics, and although the most frequent cause of these symptoms is infectious, many of them are labeled as allergic to these drugs.BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrugresistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life.Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial and new diagnostic perspectives are changing the paradigm of BL allergy management in children.Traditionally, drug provocation testing (DPT) was only performed in patients with previous negative skin tests (STs).However, the sensitivity of STs is low, and the role of in vitro testing is not well defined in pediatric population. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions.In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.