Inpatient consultations for suspected drug hypersensitivity in children: Diagnostic outcomes of a structured work-up

Introduction Drug hypersensitivity reactions are a frequent cause of allergy consultations in hospitalized children, and challenges in delabeling may lead to inappropriate drug avoidance. This study aimed to determine the rate of drug hypersensitivity among hospitalized children referred for suspected reactions and to evaluate a structured, practical diagnostic approach tailored to the implicated drug, clinical presentation, and patient age. Method In this prospective study, children aged 0–18 years who developed suspected drug hypersensitivity reactions during hospitalization were evaluated by pediatric allergists. Bedside assessment was followed by post-discharge diagnostic testing, including skin prick-tests (SPT), intradermal tests (IDT), and drug provocation tests (DPT). Drug hypersensitivity was defined by positive SPT, IDT, or DPT results, or by clinically diagnosed anaphylaxis. Results During one year, 52 children were explored for suspected drug hypersensitivity; 46 underwent diagnostic evaluation. Drug hypersensitivity was diagnosed in 11 patients (24%) while it was excluded in 76%. Beta-lactams were the most frequently suspected and confirmed drugs. A total of 61 SPTs, 57 IDTs, and 58 DPTs were performed. Two DPTs were positive, both to teicoplanin. No severe reactions occurred during diagnostic testing. Multisystem involvement was significantly associated with confirmed drug hypersensitivity ( P = 0.023). Conclusion The majority of suspected drug hypersensitivity reactions in hospitalized children are excluded after structured evaluation. A systematic, age- and drug-tailored diagnostic approach is feasible and safe and enables effective delabeling in most cases.