Antibiotic Allergy Management in Children

Introduction to Antibiotic Allergy

The presence of a parental history of beta-lactam allergy does not constitute a significant risk factor for developing a beta-lactam allergy in children, and it does not justify avoiding these antibiotics in children without a personal history of allergic reactions 1

A label of allergy based solely on a positive family history or fear of allergy can be eliminated directly without the need for allergy testing, according to the 2023 Dutch guideline on suspected antibiotic allergy, with a moderate level of evidence and a strong recommendation 1
The history of allergy based solely on positive family history is a criterion for eliminating the allergy label without the need for additional tests, as per the guideline 1
The majority of "penicillin allergy" labels are incorrect, with studies showing that approximately only 5% of adult patients with a reported history of penicillin allergy are truly allergic 1

If there is no personal history of reaction, the child can receive beta-lactams without restrictions, regardless of family history 1
For children with a personal history of possible allergic reaction, the reaction should be classified by type and severity, and for non-severe reactions limited to the skin that occurred in remote childhood, the allergy label can be eliminated 1
For immediate non-severe reactions that occurred more than 5 years ago, the beta-lactam can be administered in a controlled environment 1
For non-severe delayed reactions that occurred more than 1 year ago, the beta-lactam can be administered without prior allergy testing 1

Allergy testing should only be considered if there is a history of severe immediate reaction, non-severe immediate reaction that occurred less than 5 years ago, or severe delayed reaction, regardless of time elapsed 1
Skin tests for penicillin allergy have a high negative predictive value (>95%) 2

Approximately 80% of patients with true penicillin allergy lose their sensitization after 10 years 2