# Italian Evidence-Based Clinical Recommendations on the Appropriateness of Prescriptions and Diagnostic Tests in Pediatric Allergology: Focus on Anaphylaxis, Drug Allergy and Hymenoptera Venom Allergy

## TL;DR

This paper provides evidence-based guidelines for managing anaphylaxis, drug allergy, and hymenoptera venom allergy in children to improve care and reduce unnecessary tests.

## Contribution

New clinical recommendations for pediatric allergology focusing on resource-efficient and standardized diagnostic practices.

## Key findings

- Rapid assessment and specialist follow-up are essential for effective anaphylaxis management in children.
- Combining skin testing, serological assays, and oral provocation tests improves beta-lactam allergy diagnosis.
- Specialist referral is crucial for children with hymenoptera venom allergy to ensure proper diagnosis and management.

## Abstract

Background/Objectives: Evidence-based recommendations are vital in healthcare to standardize care, reduce variability, and improve patient outcomes. In children, anaphylaxis, allergy to antibiotics, and hymenoptera venom allergy are among the commonest reasons for allergological evaluation. This work was intended to optimize the prescriptions for allergological evaluation and for the related diagnostic tests with the aim of improving the management of children with allergic diseases and promoting resource efficiency. Methods: A systematic literature review of the literature was performed to formulate recommendations on the diagnostic management of children with anaphylaxis, drug allergy, and hymenoptera venom allergy. Results: Effective management of anaphylaxis involves rapid assessment and specialist follow-up to identify triggers, prevent recurrence, and ensure patients and caregivers are educated and equipped with an adrenaline auto-injector. Integrating skin testing, specific serological assays, and oral provocation tests into the diagnostic process for children with suspected beta-lactam allergy enhances diagnostic accuracy and minimizes unnecessary avoidance of first-line antibiotics. Children and adolescents with systemic reactions to hymenopteran stings should be referred to an allergy specialist for diagnosis, risk assessment, management education, and adrenaline prescription. Conclusions: These recommendations may enhance care quality, minimize inappropriate prescriptions, and support standardized methods of diagnosis of allergological diseases in children.