Does that child really have an antibiotic allergy?

Most children outgrow an adverse drug reaction to oral antibiotics, according to a retrospective observational study conducted in Iceland.

One to 2 years after an antibiotic provocation test was conducted in 1440 participants aged 5 months to 18 years, investigators conducted a second provocation test in 64 of the 92 participants who showed a possible mild allergic reaction after the first test. Participants received one-tenth of a full standard dose of the same antibiotic they originally received, most often amoxicillin with or without clavulanic acid (85.7%). Late mild reactions, mostly rashes, were seen in 11 participants, and 53 had no reaction at all. Investigators concluded that it is safe to perform an oral antibiotic provocation test after a mild possible allergic reaction and that patients who have a mild reaction to antibiotics at one time may possibly be prescribed the same antibiotic later.

Thoughts from Dr Farber

Too many children and adolescents have received an erroneous diagnosis of antibiotic allergy, resulting in the use of less optimal or more expensive medicine. This study indicates that mild

confirmed allergies can be outgrown,

and a pediatrician, if comfortable doing

so, can conduct an oral challenge in the

office in these patients.

Reference:

Gu›nadóttir GK, Jónasson G, Clausen M, Sørensen TG, Kristjánsson S. Antibiotic oral provocation challenge in children. Acta Paediatr. 2022;111(5):1056-1060. doi:10.1111/apa.16211