# Updates in Pediatric Drug Allergy

## TL;DR

This review updates allergists on recent changes in diagnosing and managing drug allergies in children, especially for antibiotics and NSAIDs.

## Contribution

The paper highlights standardized diagnostic approaches and updated protocols for drug allergy testing in pediatrics.

## Key findings

- A standard amoxicillin dose is now used for direct provocation challenges.
- Skin testing is being replaced by single-day oral challenges for antibiotic allergy labels.
- New severity scales and lower thresholds improve management of drug allergy reactions.

## Abstract

This review is aimed to update clinical allergists on recent international changes in classification, diagnosis, and management of pediatric drug allergy with a focus on antibiotics and NSAID allergy labels.

Guidelines have begun to standardize nomenclature, classification, and diagnostic approaches. In a progressive update, there is now a standard amoxicillin dose for direct provocation challenges, a defined severity scale for immediate reactors, and decreased threshold to drug provocation challenges for patients with serum sickness like reactions. Within antibiotic allergy label investigation, skin testing is being bypassed in favor of direct oral challenges performed in a single day without the use of extended challenges.

Continued investigation of the index reaction phenotypes, safety of drug challenges, and diagnostic certainty of in vitro studies will continue to advance the field of pediatric drug allergy.