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Drug hypersensitivity reactions in children in clinical practice: A WAO Statement☆

WAO · 2025 · international

Source and licence

Authors
Steering Committee Authors, M. Pilar Berges-Gimeno, Emilio Alvarez-Cuesta et al.
Title
Drug hypersensitivity reactions in children in clinical practice: A WAO Statement☆
Journal
The World Allergy Organization Journal, 2025
DOI
10.1016/j.waojou.2025.101087
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC12419032

Licence statement of the original publication

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

We found no explicitly labelled recommendations in this publication; its recommendations are in the running text of the original.

Abstract

Drug hypersensitivity reactions (DHRs) in children and adolescents are less common than in adults but can have serious consequences if mismanaged. Mislabeling children as drug-allergic due to incomplete diagnostic evaluations leads to unnecessary medication restrictions, increased healthcare costs, and suboptimal treatment choices. This Statement from the World Allergy Organization (WAO) provides evidence-based recommendations for evaluating and managing pediatric DHRs, emphasizing accurate diagnosis through in vivo and in vitro testing, risk stratification, and personalized approaches. Antibiotics, particularly β-lactams, and non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently implicated drugs, with non-immediate reactions, such as maculopapular exanthema, being the most common presentation. The document also addresses emerging concerns, including monoclonal antibody-induced anaphylaxis and drug-induced enterocolitis syndrome. It underscores the need for specialized care in allergy centers with expertise in pediatric populations and advocates for multidisciplinary programs to manage complex cases, such as chemotherapy hypersensitivity and perioperative drug allergy. By addressing diagnostic challenges and clinical uncertainties, this document aims to improve the management of DHRs in children, reduce mislabeling, and enhance patient outcomes worldwide.

Contents of the original publication

The section headings of the original.

  • Introduction
  • An overview of drug allergy in pediatric population—Epidemiology (Berges-Gimeno)
  • Mechanisms and clinical responses to drugs in pediatric population: breaking views (Guzman-Melendez)
  • Allergy diagnostic workup
  • In vivo diagnostic tests (Berges-Gimeno)
  • In vitro diagnostic test (Mayorga)
  • Evaluation and management specific drugs
  • Beta-lactam antibiotics (Atanaskovic-Markovic)
  • Non-betalactam antibiotics (Mori)
  • Non-steroidal anti-inflammatory drugs (NSAIDs) (White)
  • Vaccines (Caubet)
  • Antiepileptic drugs (AEDs) (Kuyucu)
  • Radiocontrast media (Rebelo Gomes)
  • Severe cutaneous adverse reactions (SCARS)
  • Drug reaction with eosinophilia and systemic symptoms (DRESS) (Caffarelli)
  • Stevens-Johnson Syndrome (SJS)/Toxic epidermal necrolysis (TEN) (Berges-Gimeno)
  • Raising awareness on a newly identified type of reaction
  • Drug-induced enterocolitis syndrome in children (DIES) (Attanasi)
  • Multidisciplinary programs to address highly complex drug allergy
  • Hypersensitivity to chemotherapy and biologics (Madrigal-Burgaleta and Alvarez-Cuesta)
  • Drug hypersensitivity reactions (DHRs) in cystic fibrosis (CF) (Madrigal-Burgaleta and Alvarez-Cuesta)
  • Peri-operative drug allergy (POH) (Powell and du Toit)
  • CONCLUSION (Berges-Gimeno)
  • Submission Declaration

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