Drug allergy claims in children: from self-reporting to confirmed diagnosis

Summary Background Poorly documented self‐reported drug allergy (DAll) is a frequent problem in daily clinical practice and has a considerable impact on prescription choices. The diagnostic work‐up of drug hypersensitivity (DHs) allows a better classification of the reactions and provides patients with more reliable information and recommendations for future treatments. Objective To assess the prevalence of self‐reported adverse drug reactions (ADRs) and DAll in a paediatric population and to investigate children reporting suspected DAll in order to achieve a firm diagnosis. Design The first phase was based on a cross‐sectional survey assessing the life occurrence of ADRs and self‐reported DAll carried out at the outpatient clinic of a paediatric hospital. The second phase was based on the diagnostic work‐up in children with parent‐reported DAll, including detailed anamnesis and in vitro and in vivo investigations (skin and provocation tests). Participants One thousand four hundred and twenty‐six parents responded to the initial survey. Sixty of the 67 patients with reported DAll were evaluated at the allergy clinic. Results The prevalences of self‐reported ADRs and DAll were 10.2% and 6.0%, respectively. Most of the suspected allergic reactions were non‐immediate cutaneous events attributable to β‐lactam antibiotics and occurred in very young children. Thirty‐nine of the 60 patients consulting for evaluation had a plausible clinical history and were recommended further investigation. DHs was diagnosed in three children only, based on positive responses in skin (n=1) and oral provocation (n=2) tests. Conclusion ADRs are frequently reported in children, and many children are classified as having a DAll. After complete evaluation, only a few of these reactions can be attributed to DHs and DAll. Most of the patients (94% in this study) could actually tolerate the initially suspected drug.