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Vol. 48. Issue 5.
Pages 417-423 (September - October 2020)
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Vol. 48. Issue 5.
Pages 417-423 (September - October 2020)
Original article
DOI: 10.1016/j.aller.2020.01.005
Allergy to beta-lactam antibiotics in children: Risk factors for a positive diagnostic work-up
E. Dias de Castroa,b,
Corresponding author

Corresponding author.
, F. Carolinoa, L. Carneiro-Leãoa, J. Barbosac,d, L. Ribeiroc,e,f, J.R. Cernadasa
a Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, Porto, Portugal
b MedInUP – Center for Drug Discover and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal
c Public Health and Forensic Sciences and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal
d UNIC – Cardiovascular Research and Development Unit, University of Porto, Porto, Portugal
e Biomedicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
f I3S – Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Tables (2)
Table 1.
Table 2. Demographic and clinical characteristics.
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Allergy to beta-lactam (βL) antibiotics is highly reported in children, but rarely confirmed. Risk factors for a positive diagnostic work-up are scarce.

The primary aim was to characterize the cases of children with confirmed βL allergy, investigating potential risk factors. Secondary aims were to assess the prevalence of allergy to βL in this population and to confirm the safety of less extensive diagnostic protocols for milder reactions.


We reviewed the clinical data from all children evaluated in our Department for suspected βL allergy, over a six-year period.


Two hundred and twenty children (53% females) with a mean age of 6.5±4.2 years were evaluated. Cutaneous manifestations were the most frequently reported (96.9%), mainly maculopapular exanthema (MPE). The reactions were non-immediate in 59.5% of the cases.

Only 23 children (10.5%) were diagnosed with allergy to βL. The likelihood of βL allergy was significantly higher in children with a family history of drug allergy (p<0.001) and in those with a smaller time period between the reaction and the study (p=0.046). The probability of not confirming βL allergy is greater in children reporting less severe reactions (p<0.001) and MPE (p<0.001).

We found the less extensive diagnostic protocol in milder reactions safe, since only 4.2% of the children presented a positive provocation test (similar reaction as the index reaction).


This study highlights family history of drug allergy as a risk factor for a positive diagnostic work-up. Larger series are required, particularly genetic studies to accurately determine future risk for βL allergy in children.

Drug allergy
Beta-lactam antibiotics
Allergy diagnostic work-up
Risk factors


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