Study of Skin Rashes After Antibiotic Use in Young Children

Immunoglobulin E (IgE)-mediated drug sensitivity in children is uncommon. However, undefined skin rash following antibiotic ingestion in younger children is commonly observed in clinical practice. We studied 86 consecutively referred patients to our allergy clinic over a 5-year period. We found that the majority of children (80%) with skin rashes were under 3 years of age. All the children had been treated with antibiotics for a bacterial upper respiratory infection (URI; otitis media, sinusitis, or pharyngitis), 73 (85%) had erythematous rash, 13 (15%) had urticaria occurring 3-5 days after the treatment, and 43 (50%) reported a repeated rash with the use of two or more different antibiotics. There were no reports of systemic reactions or histories of accompanying food allergy. When patients were given the suspected antibiotics while they were well, none developed rash. However, in the next bacterial infection, 62 (72%) chose to receive dye-free suspensions of the suspected antibiotics. Only three patients (3.5%) elected for the dye-containing suspension. Of the 62 patients who received dye-free suspensions, only eight developed a mild skin rash, which was managed successfully. We conclude that a practical approach for non-IgE-mediated skin rash needs to be evaluated. The current practice of complete avoidance of the suspected antibiotics without further evaluation may be unwarranted.