Introduction
This guideline relates to suspected
medication allergies in paediatric patients. For more information please visit:
Allergy and Immunology : Allergy and
Immunology
Antibiotics are the most common cause of serious allergic drug reactions
in children. Other common agents are anaesthetic agents, NSAIDS or aspirin.
An allergic reaction may involve one or more of the following
signs and symptoms:
Mild to moderate local allergic
reaction
- Swelling
of lips, face or eyes
- Hives or welts. Note: Maculopapular rashes may suggest a
non IgE medicated allergic reaction
Moderate
local allergic reaction
- Abdominal pain or vomiting
Severe systemic allergic reaction
(anaphylaxis)
- Difficulty
breathing
- Swelling of the tongue and/or throat
- Difficulty talking
- Hoarse voice, wheezing or persistent coughing
- Loss of consciousness and/or collapse
- Infants and young children appearing pale and floppy
Severe allergic reaction (anaphylaxis) will typically include
multiple organ systems (i.e. hives and respiratory symptoms).
When to refer
- ALWAYS refer confirmed or suspected anaphylaxis to the RCH Department of Allergy and Immunology. This is an URGENT REFERRAL.
- For allergy skin tests
- For challenge testing to confirm the diagnosis
- Where there is no other drug alternative (e.g., insulin,
chemotherapy or penicillin) and desensitisation is required to get the
child onto the drug without causing a severe allergic reaction (transient
intolerance)
Do not refer
- For
allergy screening if there is no clear history of allergic reaction
- When there is a family history of drug allergy and a
healthy patient who has not had an allergic reaction to a drug
- For drug reaction if the reaction was mild, there are
alternative drugs available and avoidance is an option for management
(e.g., Ceclor reactions)
Services available
closer to home
Alternative paediatric allergy
services available in Victoria include:
- Public paediatric allergy services:
- The Northern Hospital
- Sunshine Hospital
- Monash Children’s Hospital
- Consider referral to a private allergist as an
alternative to RCH. Options available on ASCIA website: Locate a
specialist
Referral
criteria/required information
The GP at first consultation is in the best position to get the
most comprehensive information from parents on the details of an allergic
reaction. Please collect and include in your referral as much detail as
possible. Referrals may be rejected if information is insufficient to triage
appropriately
Please include:
- CLEARLY INDICATE if the child has confirmed or
suspected ANAPHYLAXIS. The referral will be triaged as urgent
- Date reaction(s) occurred
- Allergic reaction signs/symptoms (see mild,
moderate and severe symptoms above)
- Potential causes of reaction(s) e.g., which drug/s?
- When, where and how did the reaction(s) happen (include timing of onset
in relation to dose and duration after cessation of drug)?
- RAST results
- Treatment given and patient response
- Previous or subsequent exposure to allergen
How to refer
Please complete the above and submit via:
Suggested pre-referral work-up/management
History:
- Drug: type, amount, form ingested
- Nature of reaction:
o
Timing of onset in relation to dose
o
Duration of reaction after cessation of drug
- Previous or subsequent exposure
to the suspected drug?
- Drugs taken safely in the past that have not
caused allergic reactions
Diagnostics:
- RAST
test may be helpful for penicillin and penicillin derivatives (eg:
penicillin major determinant, benzyl penicillin G, amoxycilloyl).
- Only RAST test for drug
allergy if suspect IgE-mediated reaction (not useful for non IgE mediated)
- Skin testing should only be
performed by a specialist allergist
- Do not attempt to perform a challenge to the
allergen. This should only be done in a specialist allergy unit
- Interpretation of RAST test or SPT (Skin Prick
Test)
- Test
results should be interpreted together with history
- RAST may be falsely
negative
- Positive
allergen-specific IgE (RAST or SPT) in the presence of a clear history of
allergic reaction, confirms clinical allergy
Management:
- Discontinue
the drug
- If alternative antibiotics are available on
the market, choose one of equal efficacy
- Amoxicillin or penicillin-derivative reactions
need avoidance of all penicillin derivative antibiotics
- Paracetamol can be used as an alternative to
aspirin
- Refer patient to Allergy and
Immunology specialist for further management and instruct patient to avoid
the specified drug
Information for
families
Resources and links
Acknowledgements
The
development of this guideline
was coordinated by the Department of Allergy and
Immunology (Dr Jo Smart and Dr Paulina Alhucema). Guideline reviewed in January 2025.