Drug hypersensitivity reactions in children in clinical practice: A WAO Statement
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,...
| Published in: | World Allergy Organization Journal |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S193945512500064X |
| _version_ | 1849327722151542784 |
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| author | M. Pilar Berges-Gimeno, MD, PhD Emilio Alvarez-Cuesta, MD, PhD, MQM Marina Atanaskovic-Markovic, MD, PhD Marina Attanassi, MD, PhD Carlo Caffareli, MD, PhD Jean-Christoph Caubet, MD George du Toit, MBBCh, MRCPCH Antonieta Guzman-Melendez, MD, PhD Semanur Kuyucu, MD, PhD Ricardo Madrigal-Burgaleta, PhD, FRCP Lina Mayorga, MD, PhD Elizabeth Powell, MBChB, PhD Michelle Ramien, MD, MSc Eva Rebelo Gomes, MD, PhD Francesca Mori, MD, PhD Andrew A. White, MD Ignacio J. Ansotegui, MD, PhD Marcelo Vivolo Aun, MD, PhD Annick Barbaud, MD, PhD Sevim Bavbek, MD, PhD Lorena Bernal-Rubio, MD Knut Brockow, MD (Prof. Dr. med) Lucrecia Bustamante, MD Yoon-Seok Chang, MD, PhD Luis Felipe Chiaverini Ensina, MD, MSc, PhD Javier Cuesta-Herranz, MD, PhD Bryan N. Fernandes, MBBS, MRCP Lene Heise Garvey, MD, PhD Pedro Giavina-Bianchi, MD, PhD Mona I. Kidon, MD Marina Labella Alvarez, MD, PhD Joanna S. Makowska, MD Susana Marinho, MD, PhD David Alejandro Mendoza-Hernández, MD Mauro Pagani, MD Valeria Palma Pino, MD Claudio A.S. Parisi, MD Hae-Sim Park, MD Jonathan Peter, MBChB, PhD Elizabeth J. Phillips, MD Kimberly Risma, MD, PhD Emilio Solano-Solares, MD, PhD Luciana Kase Tanno, MD, PhD Rocco Luigi Valluzzi, MD Paula Vazquez-Revuelta, MD Timothy J. Watts, MBBS, FRCP Masao Yamaguchi, MD, PhD |
| author_facet | M. Pilar Berges-Gimeno, MD, PhD Emilio Alvarez-Cuesta, MD, PhD, MQM Marina Atanaskovic-Markovic, MD, PhD Marina Attanassi, MD, PhD Carlo Caffareli, MD, PhD Jean-Christoph Caubet, MD George du Toit, MBBCh, MRCPCH Antonieta Guzman-Melendez, MD, PhD Semanur Kuyucu, MD, PhD Ricardo Madrigal-Burgaleta, PhD, FRCP Lina Mayorga, MD, PhD Elizabeth Powell, MBChB, PhD Michelle Ramien, MD, MSc Eva Rebelo Gomes, MD, PhD Francesca Mori, MD, PhD Andrew A. White, MD Ignacio J. Ansotegui, MD, PhD Marcelo Vivolo Aun, MD, PhD Annick Barbaud, MD, PhD Sevim Bavbek, MD, PhD Lorena Bernal-Rubio, MD Knut Brockow, MD (Prof. Dr. med) Lucrecia Bustamante, MD Yoon-Seok Chang, MD, PhD Luis Felipe Chiaverini Ensina, MD, MSc, PhD Javier Cuesta-Herranz, MD, PhD Bryan N. Fernandes, MBBS, MRCP Lene Heise Garvey, MD, PhD Pedro Giavina-Bianchi, MD, PhD Mona I. Kidon, MD Marina Labella Alvarez, MD, PhD Joanna S. Makowska, MD Susana Marinho, MD, PhD David Alejandro Mendoza-Hernández, MD Mauro Pagani, MD Valeria Palma Pino, MD Claudio A.S. Parisi, MD Hae-Sim Park, MD Jonathan Peter, MBChB, PhD Elizabeth J. Phillips, MD Kimberly Risma, MD, PhD Emilio Solano-Solares, MD, PhD Luciana Kase Tanno, MD, PhD Rocco Luigi Valluzzi, MD Paula Vazquez-Revuelta, MD Timothy J. Watts, MBBS, FRCP Masao Yamaguchi, MD, PhD |
| author_sort | M. Pilar Berges-Gimeno, MD, PhD |
| collection | DOAJ |
| container_title | World Allergy Organization Journal |
| description | 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. |
| format | Article |
| id | doaj-art-4e1b3d949b7a470ca37d54e213badb02 |
| institution | Directory of Open Access Journals |
| issn | 1939-4551 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| spelling | doaj-art-4e1b3d949b7a470ca37d54e213badb022025-08-31T04:45:51ZengElsevierWorld Allergy Organization Journal1939-45512025-09-0118910108710.1016/j.waojou.2025.101087Drug hypersensitivity reactions in children in clinical practice: A WAO StatementM. Pilar Berges-Gimeno, MD, PhD0Emilio Alvarez-Cuesta, MD, PhD, MQM1Marina Atanaskovic-Markovic, MD, PhD2Marina Attanassi, MD, PhD3Carlo Caffareli, MD, PhD4Jean-Christoph Caubet, MD5George du Toit, MBBCh, MRCPCH6Antonieta Guzman-Melendez, MD, PhD7Semanur Kuyucu, MD, PhD8Ricardo Madrigal-Burgaleta, PhD, FRCP9Lina Mayorga, MD, PhD10Elizabeth Powell, MBChB, PhD11Michelle Ramien, MD, MSc12Eva Rebelo Gomes, MD, PhD13Francesca Mori, MD, PhD14Andrew A. White, MD15Ignacio J. Ansotegui, MD, PhD16Marcelo Vivolo Aun, MD, PhD17Annick Barbaud, MD, PhD18Sevim Bavbek, MD, PhD19Lorena Bernal-Rubio, MD20Knut Brockow, MD (Prof. Dr. med)21Lucrecia Bustamante, MD22Yoon-Seok Chang, MD, PhD23Luis Felipe Chiaverini Ensina, MD, MSc, PhD24Javier Cuesta-Herranz, MD, PhD25Bryan N. Fernandes, MBBS, MRCP26Lene Heise Garvey, MD, PhD27Pedro Giavina-Bianchi, MD, PhD28Mona I. Kidon, MD29Marina Labella Alvarez, MD, PhD30Joanna S. Makowska, MD31Susana Marinho, MD, PhD32David Alejandro Mendoza-Hernández, MD33Mauro Pagani, MD34Valeria Palma Pino, MD35Claudio A.S. Parisi, MD36Hae-Sim Park, MD37Jonathan Peter, MBChB, PhD38Elizabeth J. Phillips, MD39Kimberly Risma, MD, PhD40Emilio Solano-Solares, MD, PhD41Luciana Kase Tanno, MD, PhD42Rocco Luigi Valluzzi, MD43Paula Vazquez-Revuelta, MD44Timothy J. Watts, MBBS, FRCP45Masao Yamaguchi, MD, PhD46Department of Allergy, Hospital Universitario Ramón y Cajal, SpainAcademic in Allergy and Immunology, Allergy Division, Former Head, Ramon & Cajal University Hospital, Madrid, SpainDepartment of Allergology and Pulmonology, University Children’s Hospital, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, SerbiaDepartment of Pediatrics, University of Chieti, Chieti, ItalyClinica Pediatrica, Dipartimento di Medicina e Chirurgia, Azienda Ospedaliero-Universitaria, Università di Parma, ItalyPediatric Allergy Unit, Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, SwitzerlandDepartment of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UKSection of Immunology, HIV and Allergy, Department of Medicine, Clinical Hospital University of Chile, ChileDepartment of Paediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, TurkeyAllergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Corresponding author. Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust West Smithfield, London EC1A 7BE, United Kingdom.Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, SpainDepartment of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UKDepartment of Pediatrics, University of Calgary, Alberta Children’s Hospital, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, CanadaAllergy and Clinical Immunology Department, Centro Hospitalar Universitário Santo António, Porto, PortugalAllergy Unit, Meyer Children’s Hospital IRCCS, Florence, ItalyDivision of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California, USAHospital Quironsalud, Bizkaia, Bilbao-Erandio, SpainFaculdade Israelita de Ciências da Saúde Albert Einstein School of Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil; Clinical Immunology and Allergy and Immunology Division, University of São Paulo, São Paulo, BrazilSorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, FranceDivision of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, TurkeyDepartment of Allergy, Hospital Universitario Ramón y Cajal, SpainDepartment of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine and Health, Munich, GermanyHospital Italiano of Buenos Aires, ArgentinaDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDivision of Allergy, Clinical Immunology and Rheumatology, Department of Paediatrics, Federal University of São Paulo, BrazilDepartment of Allergy and Immunology, IIS-Fundación Jiménez Díaz UAM, SpainAllergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UKAllergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, DenmarkUniversity of São Paulo, BrazilDepartment of Pediatrics, Faculty of Medical & Health Sciences, Tel Aviv University and Sheba Medical Center, IsraelHospital Regional Universitario de Málaga, SpainDepartment of Rheumatology, University of Lodz, PolandAllergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, UKInstituto Nacional de Pediatría, Mexico City, MexicoASST Mantova, ItalyClinical Hospital, University of Chile, Santiago, ChileHospital Italiano de Buenos Aires, ArgentinaDepartment of Allergy and Clinical Immunology, Ajou University School of Medicine, South KoreaDivision of Allergology, University of Cape Town, South AfricaCenter for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USADivision of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USADepartment of Allergy, Ramón y Cajal University Hospital, Madrid, SpainDivision of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France; Desbrest Institute of Epidemiology and Public Health, UMR 1318 University of Montpellier - INSERM, FranceTranslational Research in Pediatric Specialties Area, Division of Allergy, Bambibno Gesù Children's Hospital, IRCCS, Rome, ItalyDrug Desensitization Center, Catalan Institute of Oncology, Barcelona, Spain; Allergy Service, Bellvitge University Hospital, Barcelona, SpainDepartment of Respiratory Medicine & Allergy, Homerton Healthcare NHS Foundation Trust, London, UKDivision of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, JapanDrug 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.http://www.sciencedirect.com/science/article/pii/S193945512500064X |
| spellingShingle | M. Pilar Berges-Gimeno, MD, PhD Emilio Alvarez-Cuesta, MD, PhD, MQM Marina Atanaskovic-Markovic, MD, PhD Marina Attanassi, MD, PhD Carlo Caffareli, MD, PhD Jean-Christoph Caubet, MD George du Toit, MBBCh, MRCPCH Antonieta Guzman-Melendez, MD, PhD Semanur Kuyucu, MD, PhD Ricardo Madrigal-Burgaleta, PhD, FRCP Lina Mayorga, MD, PhD Elizabeth Powell, MBChB, PhD Michelle Ramien, MD, MSc Eva Rebelo Gomes, MD, PhD Francesca Mori, MD, PhD Andrew A. White, MD Ignacio J. Ansotegui, MD, PhD Marcelo Vivolo Aun, MD, PhD Annick Barbaud, MD, PhD Sevim Bavbek, MD, PhD Lorena Bernal-Rubio, MD Knut Brockow, MD (Prof. Dr. med) Lucrecia Bustamante, MD Yoon-Seok Chang, MD, PhD Luis Felipe Chiaverini Ensina, MD, MSc, PhD Javier Cuesta-Herranz, MD, PhD Bryan N. Fernandes, MBBS, MRCP Lene Heise Garvey, MD, PhD Pedro Giavina-Bianchi, MD, PhD Mona I. Kidon, MD Marina Labella Alvarez, MD, PhD Joanna S. Makowska, MD Susana Marinho, MD, PhD David Alejandro Mendoza-Hernández, MD Mauro Pagani, MD Valeria Palma Pino, MD Claudio A.S. Parisi, MD Hae-Sim Park, MD Jonathan Peter, MBChB, PhD Elizabeth J. Phillips, MD Kimberly Risma, MD, PhD Emilio Solano-Solares, MD, PhD Luciana Kase Tanno, MD, PhD Rocco Luigi Valluzzi, MD Paula Vazquez-Revuelta, MD Timothy J. Watts, MBBS, FRCP Masao Yamaguchi, MD, PhD Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title | Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title_full | Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title_fullStr | Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title_full_unstemmed | Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title_short | Drug hypersensitivity reactions in children in clinical practice: A WAO Statement |
| title_sort | drug hypersensitivity reactions in children in clinical practice a wao statement |
| url | http://www.sciencedirect.com/science/article/pii/S193945512500064X |
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