GROWING recognition that most childhood antibiotic allergy labels are inaccurate has driven an urgent call for standardised testing practices. In a new report, investigators from the US Drug Allergy Registry Pediatrics (USDAR-Peds) introduce unified, evidence-informed protocols designed to guide clinicians in evaluating suspected antibiotic hypersensitivity in children, an effort aimed at reducing inappropriate avoidance and enabling more reliable research across multiple centres.
A Need for Harmonisation in Pediatric Allergy Care
Pediatric antibiotic allergy evaluation presents challenges not routinely seen in adults: frequent early-life antibiotic exposure, short intervals between reaction and assessment, and high rates of mislabelling due to viral exanthems and medication side-effects. Without standardised methods, families face inconsistent advice, clinicians often hesitate to de-label, and multisite research becomes difficult to interpret. The USDAR-Peds initiative brings a unified clinical framework to this fragmented landscape.
Standardised Protocols to Support Safe, Accurate Testing
The new guidance emphasises carefully structured approaches to skin testing and direct oral challenges, clarifying dose strategies, observation periods, and interpretation criteria tailored to children. The authors also introduce a pediatric-specific adaptation of the USDAR immediate-reaction grading scale, enabling consistent categorisation of positive reactions, critical for both safety and high-quality multicentre data.
Addressing Mislabeling and Improving Outcomes
Unnecessary avoidance of β-lactams contributes to broader-spectrum prescribing, increased resistance, and higher healthcare utilisation. By identifying an “actionable window” early in life, the report argues that timely evaluation can significantly reduce long-term morbidity linked to incorrect allergy labels. The guidance also prepares the foundation for studying non–IgE-mediated reactions, including delayed morbilliform eruptions and serum sickness–like reactions.
Toward a National Pediatric Allergy Framework
Developed through repeated consensus meetings and grounded in current evidence, these protocols represent the first coordinated national approach to pediatric antibiotic allergy testing. The authors note that further harmonisation will eventually extend to delayed organ reactions and other drug classes, but unifying antibiotic allergy evaluations is a pivotal first step toward improving care and strengthening research infrastructure.
Reference
Accarino JO et al. A Guide to Pediatric Antibiotic Allergy Testing: A Report From the US Drug Allergy Registry. JACI: In Practice. 2025;13(5):1018-26.
