How to Manage Drug-Induced Exanthema in Children

Exanthemas are frequently encountered in the pediatric population and often occur while patients concomitantly receive a drug, leading to a high prevalence of suspicion of drug allergy in children. Although the vast majority of these exanthemas are due to the underlying infection, most of those patients are falsely labeled as “drug allergic” without appropriate testing, mostly due to fear of life-threatening reactions. Overdiagnosis of drug allergy constitutes a major public health problem by increasing health costs and by contributing to overall antibiotic resistance. Thus, an accurate diagnosis is considered as a major contribution to cost-effective health care and will be based on a complete allergic workup (i.e., clinical history, skin tests, in vitro tests, and/or drug provocation test). Specific aspects of the management of drug allergy have been highlighted recently, particularly regarding the importance and safety of the drug provocation test as well as the low diagnostic value of skin tests in the diagnosis of betalactam allergy.