D2.88 - Drug Provocation Testing for Suspected Beta-Lactam Allergy in Children: Experience from a Secondary Hospital in the Community of Madrid

Beta-lactam allergy is the most frequently reported drug allergy in children; however, confirmed hypersensitivity is identified in only a minority of cases. The European Academy of Allergy and Clinical Immunology (EAACI) guidelines recommend drug provocation testing (DPT) as the reference standard in children with non-severe index reactions and negative allergy work-up, in order to prevent inappropriate allergy labeling.

We performed a retrospective review of pediatric patients evaluated for suspected beta-lactam allergy between January 2024 and December 2025. All patients had negative specific IgE and skin prick tests prior to DPT. Demographic data, suspected drug, characteristics of the index reaction, and DPT outcomes were analyzed.

Seventy-two DPTs were conducted. Fifty-eight percent of patients were male, with a mean age of 8.7 years. The most frequently tested drugs were amoxicillin (69.4%) and amoxicillin-clavulanate (20%). The most commonly reported index reaction was urticaria, predominantly occurring on day 4 or later during treatment.

Four patients (5.5%) developed reactions during DPT: one immediate reaction (8 hours after administration) and three non-immediate reactions. All reactions were mild and limited to cutaneous manifestations. No systemic or severe reactions were observed.

Our findings are consistent with EAACI guidelines, demonstrating a low rate of positive DPTs in appropriately selected pediatric patients and a favorable safety profile, with reactions predominantly mild and cutaneous. DPT represents a safe and reliable diagnostic tool in this setting. Active removal of an inaccurate beta-lactam allergy label is essential to improve antibiotic stewardship, reduce unnecessary use of broad-spectrum alternatives, and optimize pediatric patient care.