Drug Allergy Labels Common in Kids With Immunodeficiency, Often Incorrect

Children with primary immunodeficiencies, conditions that weaken the immune system, frequently receive antibiotic treatment, often as a preventative measure. However, a significant number are incorrectly labeled with drug allergies, potentially limiting their treatment options. New data presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting suggests that nearly 90% of these allergy labels can be safely removed after appropriate testing, opening up crucial antibiotic choices for a vulnerable population.

The research, led by Christine Rukasin, MD, FAAAAI, of Phoenix Children’s, examined the medical records of 219 children with immunodeficiency treated between January 2022 and March 2025. The study highlighted a substantial burden of drug allergy labels – nearly half of the children (48.4%) had at least one, with over a quarter (24.7%) reporting multiple allergies. Antibiotics accounted for over 43% of these labels, with penicillin allergies being the most common.

Antibiotic Allergies and Immunodeficiency: A Complex Interplay

Children with primary immunodeficiencies are predisposed to infections and often rely on antibiotics for both treatment and prevention. Incorrectly identified drug allergies can severely restrict the antibiotics available to these patients, potentially leading to the apply of broader-spectrum alternatives. These alternatives may have more side effects, contribute to antibiotic resistance, and are associated with longer hospital stays and increased readmission rates, according to the researchers.

“If they don’t have access to the most effective antibiotics, this may lead to less optimal treatment,” Rukasin explained. The study revealed that 45 patients were already receiving prophylactic antibiotics, with azithromycin and trimethoprim/sulfamethoxazole being frequently used. The presence of a drug allergy label could further limit choices in these cases.

Testing Reveals High Rate of ‘False’ Allergies

Importantly, the researchers found that allergy testing was performed in a relatively small proportion of patients – just 18.9%. However, among those tested, a remarkable 85% (17 out of 20) were successfully “delabeled,” meaning they were found not to be truly allergic to the medication in question. This suggests a significant opportunity to improve antibiotic stewardship and treatment outcomes in this population.

The study’s findings are particularly relevant given the increasing concern about antibiotic resistance. By accurately identifying and removing unnecessary drug allergy labels, clinicians can ensure that patients with immunodeficiency have access to the full range of antibiotics needed to fight infections effectively.

What the Study Doesn’t Tell Us

While the study provides compelling evidence for the benefit of allergy testing, it’s significant to acknowledge its limitations. The retrospective nature of the study means that the data was collected from existing medical records, which may be subject to inaccuracies or incomplete information. The study was conducted at a single institution, which may limit the generalizability of the findings to other populations or healthcare settings. The researchers also did not investigate the reasons *why* these allergy labels were initially assigned, which could provide valuable insights into preventing future mislabeling.

The Role of Allergy Evaluation

Rukasin emphasizes the importance of a thorough evaluation for patients with suspected drug allergies. “It is surprising that so few of them are referred for complete formal evaluation, but for those who completed testing, it opened up treatment options since testing is commonly negative,” she noted. She also suggests that clinicians should actively inquire about the circumstances surrounding the initial allergy label, as some reactions may have been adverse effects rather than true allergic responses.

The researchers advocate for increased awareness of the potential for misdiagnosis and encourage clinicians to refer patients with drug allergy labels to an allergist for comprehensive testing. This proactive approach could significantly improve the quality of care for children with primary immunodeficiencies.

What’s Next: Expanding Access to Allergy Testing

Phoenix Children’s is actively working to expand the reach of its drug allergy program through multidisciplinary collaboration. This includes developing strategies to identify and evaluate patients with drug allergy labels more efficiently and effectively. Further research is needed to determine the optimal approach to allergy testing in this population and to assess the long-term impact of delabeling on clinical outcomes.

The findings underscore the need for a systematic approach to managing drug allergies in children with primary immunodeficiencies. By prioritizing allergy evaluation and delabeling, healthcare providers can assist ensure that these vulnerable patients have access to the antibiotics they need to stay healthy. For more information, Christine Rukasin, MD, FAAAAI can be contacted directly.

You can learn more about primary immunodeficiencies from the Immune Deficiency Foundation. Information on antibiotic resistance can be found on the Centers for Disease Control and Prevention (CDC) website. Finally, the American Academy of Allergy, Asthma & Immunology (AAAAI) provides resources for both patients and healthcare professionals.