Antibiotics Identified as Leading Cause of Anaphylaxis in Children in new study

A new study published in the European Journal of Pediatrics showed that antibiotics, particularly ceftriaxone, were the most commonly related to anaphylactic reactions in children. This highlights the need for heightened awareness and careful monitoring when prescribing antibiotics to pediatric patients.

Drugs are the most common etiological agents in deadly anaphylaxis in most areas where data is available. Data on drug-induced anaphylaxis in children are sparse, with most case studies including adult populations. Azize Pınar Metbulut and crew conducted this study to understand demographics, clinical manifestations, risk factors, causative agents, and therapy options for drug-related anaphylaxis in the pediatric population.

Pediatric patients between the ages of 1 month and 18 months, who were admitted to the Pediatric Allergy and Immunology outpatient clinics of 11 participating centers between January 2017 and December 2022 with a presumptive diagnosis of drug-induced anaphylaxis and who met the standard criteria for anaphylaxis were included in this multicenter retrospective study.

A total of 293 anaphylactic incidents that occurred in 265 individuals were included, of which 48.1% (n 141) were female. During the index event, the median age of the patients was 107 months. When compared to home surroundings, hospital settings had a higher rate of anaphylaxis. In 40.3% of the instances, the administration was peroral, and in 59.7%, it was parenteral.

The most often suspected medication classes were antibiotics, non-steroidal anti-inflammatory medicines, and chemotherapeutics; nevertheless, the most prevalent culprits among antibiotics were the cephalosporin group, particularly ceftriaxone. 39.6% of the events had severe anaphylaxis, whereas 54.9% had mild anaphylaxis.

5 of the patients experienced a biphasic response. Adrenaline therapy was administered to only 72% of patients. A total of 39 individuals were confirmed by diagnostic tests, comprising skin prick, intradermal, and drug provocation tests, conducted between 1 and 120 months following the index response.

The results showed positive results in 23.4%, 17.2%, and 20.3% of instances, respectively. Protocols for possible drug desensitization were performed on four individuals. Overall, algorithmic assessment is necessary for pediatric patients suffering from drug-related anaphylaxis in order to guarantee a precise diagnosis, stop recurrence, and find safe substitute therapies.

Source:

Metbulut, A. P., Haci, İ. A., Can, D., Bekiş Bozkurt, H., Cavkaytar, Ö., Arga, M., Özçeker, D., Kavas Yildiz, Y., Vezir, E., Arikoğlu, T., Kuyucu, S., Azkur, D., Güvenir, H., Kendirci, N., Orhan, F., Usta Güç, B., Bahçeci, S., & Dibek Misirlioğlu, E. (2025). Evaluation of drug-related anaphylaxis in children: multi-center study. European Journal of Pediatrics, 184(3), 230. https://doi.org/10.1007/s00431-025-06068-x