Evaluation of pediatric patients with drug allergy confirmed by in vivo diagnostic tests

Abstract Background and Objective Adverse drug reactions (ADRs) are a serious public health problem. This study aimed to evaluate reaction characteristics and diagnostic test results in pediatric patients in whom suspected drug allergy was confirmed by in vivo diagnostic tests. Methods Children who presented with suspected drug allergy between January 1, 2013 and January 1, 2023 in Ankara, Türkiye and underwent in vivo diagnostic testing were included in the study. Patients with positive diagnostic tests were compared with those whose tests resulted negative. Results Over the 10‐year study period, 1818 patients presented with suspected drug allergy and were followed up for 1892 presumed drug‐associated hypersensitivity reactions. A total of 4532 in vivo diagnostic tests were performed with the 2082 suspect drugs implicated in these reactions. Drug allergy was confirmed by in vivo diagnostic tests in 225 patients (12.5%). A total of 242 (5.3%) tests resulted positive, with positivity rates of 1.3% for skin prick tests (SPTs), 2.7% for intradermal tests (IDTs), 19.4% for patch tests and 8.5% for drug provocation tests (DPTs). Among patients with positive in vivo diagnostic test results, the most common suspect drugs were antibiotics (53.9%), followed by non‐steroidal anti‐inflammatory drugs (NSAIDs; 31.5%) and antiepileptic drugs (7.4%). There was no significant difference between patients with positive and negative diagnostic test results in terms of sex (50.2% vs. 53.4%, p = .36). However, age at reaction was significantly higher among patients with positive diagnostic test results (92 vs. 49 months, p < .001). The prevalence of antibiotics (53.9% vs. 78.2%) was significantly higher and the rates of NSAIDs (31.5% vs. 15%) was significantly lower in the group with negative diagnostic test results ( p < .001 for both). In both groups, the most common clinical manifestations were cutaneous symptoms (93.3% and 94.5%, p = .44). Respiratory symptoms and a history of anaphylaxis were more frequent in the group with positive test results. Conclusion The use of standardized systematic approaches for the diagnosis and management of drug hypersensitivity reactions can potentially improve outcomes, and diagnostic tests should be performed in patients with no contraindications.