The purpose of this paper is to give the most recent information on beta-lactam hypersensitivity responses in children. When studying beta-lactam allergy in children, drug provocation tests (DPTs) remain the gold standard, and evidence is increasingly supporting DPTs without skin testing as a safe method when screening children with nonimmediate moderate responses to beta-lactams. It should be noted that statistics on the adolescent population is sparse, and this attitude may not apply to this age group. In non immediate responses, standardisation of DPT procedures is essential, since various regimens spanning from 1 to 10 days have been documented. The ideal length of DPT is still unclear, with longer regimens offering somewhat more sensitivity and maybe higher long-term compliance at the price of potential antibiotic side effects. On the other hand, 1-day DPTs will identify the great majority of individuals, with the remainder developing only a minor rash after a future complete treatment. The natural history of beta-lactam allergy in children is poorly understood, with new data indicating that most diagnosed beta-lactam allergies resolve after three years.
More research is needed to standardise DPT procedures and establish the favourable natural history of beta-lactam medication allergies in children. Furthermore, multicentric studies are necessary to validate the widely accepted stance of administering DPTs without skin testing in nonimmediate moderate beta-lactam responses and to further investigate the potential of performing DPTs in children with benign immediate beta-lactam reactions.
