Challenges and preventive strategies in pediatric drug hypersensitivity reactions: where do we stand?

TL;DR

This paper reviews the challenges of managing drug allergies in children and evaluates premedication as a potential preventive strategy.

Contribution

The paper highlights the lack of strong evidence for premedication in pediatric drug hypersensitivity and calls for further research.

Findings

Premedication with H1-antihistamines may help reduce mild histamine-mediated reactions in children.

Rapid drug desensitization shows high success rates but lacks strong evidence for premedication effectiveness.

Controlled studies are needed to establish clear guidelines for pediatric drug allergy management.

Abstract

Drug hypersensitivity reactions (DHRs) in pediatric patients present significant clinical challenges due to their potential for severe, life-threatening reactions such as anaphylaxis. Although less common than in adults, DHRs in children are more difficult to diagnose and manage due to limited pediatric-specific research. This study focuses on the role of premedication as a preventive strategy for DHRs, exploring its potential benefits and limitations. While approaches like H1-antihistamines combined with gradual drug dose escalation show promise for reducing mild histamine-mediated reactions, evidence regarding premedication’s effectiveness, particularly for non-IgE-mediated mechanisms, remains inconclusive. Rapid drug desensitization (RDD) protocols demonstrate high success rates in certain cases; however, there are no strong recommendations for or against premedication, and controlled studies documenting its real efficacy are lacking. Further research is crucial to establish clear guidelines and improve the safety and outcomes of pediatric drug allergy management.

The online version contains supplementary material available at 10.1186/s13052-025-01888-x.