Diagnosis of drug hypersensitivity in children and adolescents: Discrepancy between physician‐based assessment and results of testing

Abstract

Diagnosis of drug hypersensitivity is often based on history alone. But such a vague diagnosis may cause limitations of therapeutic options in the future. To confirm or rule out drug hypersensitivity, skin testing, in vitro studies, and challenge tests are necessary. However, the diagnostic value of this complex and time-consuming allergologic work-up, especially in children, remains controversial. Aim of this retrospective analysis was to compare the results of diagnostic testing in children and adolescents with drug hypersensitivity diagnosed on clinical grounds, i.e., temporal relationship and observation of symptoms alone. We studied 43 children and adolescents (23 females, 20 males, mean age 13) with a history of immediate or delayed hypersensitivity symptoms in temporal relation to drug treatment using standardized skin testing followed by oral challenges. Patients with suspected penicillin hypersensitivity were further evaluated with in vitro tests. Drug hypersensitivity was excluded in 40 patients by tolerated oral challenge tests with the incriminated drug. In two patients, positive challenge tests confirmed non-steroidal anti-inflammatory drug hypersensitivity. One patient with amoxicillin-associated exanthema developed positive late skin test reactions to aminopenicillins. In childhood and adolescence, allergologic testing in cases of suspected drug hypersensitivity is of importance both to establish a correct diagnosis and to prevent unjustified withholding of a drug or class of drugs.