Evaluation of drug-related anaphylaxis in children: multi-center study

Abstract

The aim of the study is to elucidate demographic characteristics, risk factors, clinical presentations, causative agents, and management approaches pertaining to drug-related anaphylaxis in the paediatric population. This study is a multicenter retrospective study that included paediatric patients aged between 1 month and 18 years, who were admitted to the Pediatric Allergy and Immunology outpatient clinics of 11 participating centres with a presumptive diagnosis of drug-induced anaphylaxis, that fulfilled the standardised criteria for anaphylaxis, between January 2017 and December 2022. A total of 293 anaphylactic episodes presented among 265 patients, of which 48.1% (n 141) were female, were included. The median age of patients during the index episode was 107 months (IQR 56.5–161.5). Anaphylaxis occurred most frequently within hospital settings (62.1%, n 182) compared to home environments (34.1%, n 100). The administration were peroral in 40.3% (n 118), parenteral in 59.7% (n 175) of the cases. While antibiotics (56.7%), non-steroidal anti-inflammatory drugs (25.7%), and chemotherapeutics (3.4%) were the most commonly suspected drug groups, the cephalosporin group, and especially ceftriaxone (27.5% [n 80]) were the leading culprits among antibiotics. The anaphylaxis severity was severe in 39.6% (n 116), and moderate in 54.9% (n 161) of episodes. A biphasic reaction occurred in five patients. Only 72% (n 213) of patients were given adrenaline treatment. There were no fatalities. Diagnostic tests (n 64), including skin prick, intradermal, and drug provocation tests, which were performed between 1 and 120 months after the index reaction, yielded positive results in 23.4% (n 15), 17.2% (n 11), and 20.3% (n 13) of cases respectively, giving a total confirmation of 39 patients. Four patients underwent suspected drug desensitisation protocols. There were no fatalities. Conclusions: Antibiotics, particularly ceftriaxone, were the most commonly implicated agents in paediatric drug-induced anaphylaxis. Non-steroidal anti-inflammatory drugs, particularly ibuprofen, constituted the second most frequently implicated drug group. Paediatric patients experiencing drug-related anaphylaxis warrant algorithmic evaluation to ensure accurate diagnosis, prevent recurrence, and identify safe alternative treatments. © 2025 Elsevier B.V., All rights reserved.