Drug Allergy Labels Common in Children with Immunodeficiencies, Often Incorrect

Children with primary immunodeficiencies frequently receive drug allergy labels, but these labels are often inaccurate when formally evaluated, according to research presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.¹ The findings highlight the potential for unnecessary limitations in antibiotic treatment options for this vulnerable population.

The Challenge of Drug Allergy Labels

Children with primary immunodeficiencies, or inborn errors of immunity, often require antibiotics for both prophylactic use and treatment of active infections. However, the presence of a drug allergy label can restrict their access to the most effective antibiotics, potentially leading to longer hospital stays, increased readmission rates, and poorer clinical outcomes.¹

Study Findings

Researchers at Phoenix Children’s conducted a retrospective chart review of 219 children (57% boys; median age, 10 years; 59.8% White) with immunodeficiency treated between January 2022 and March 2025.¹ The study revealed that 106 children (48.4%) had at least one drug allergy label, with 54 (24.7%) reporting multiple labels, totaling 226 labels overall.

Antibiotics accounted for 43.4% of these labels, including:

• Penicillin: 37 labels (16.4%)
• Cephalosporin: 18 labels (8%)
• Vancomycin: 15 labels (6.6%)
• Trimethoprim/sulfamethoxazole: 9 labels (4%)

Forty-five patients (20.5%) were taking prophylactic antibiotics, with azithromycin (10.5%) and trimethoprim/sulfamethoxazole (8.2%) being the most common.¹

Importantly, only 20 drug allergy labels (18.9%) were formally evaluated by an allergist, and of those, 17 were successfully delabeled.

Implications for Clinical Practice

The researchers concluded that drug allergy labels are common among children with immunodeficiency, and that formal allergy testing can often identify these labels as inaccurate, opening up treatment options.¹

“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,” said Christine Rukasin, MD, FAAAAI, allergist and clinical immunologist at Phoenix Children’s.¹

Dr. Rukasin advises clinicians to gather detailed information about the reasons behind drug allergy labels. She suggests that some labels may be based on adverse effects that do not preclude future use of the medication, and encourages referral to an allergist for comprehensive evaluation.¹

Future Directions

Phoenix Children’s drug allergy program continues to expand its impact through multidisciplinary collaboration. Further research and increased awareness of the benefits of allergy testing are crucial to optimize antibiotic treatment strategies for children with primary immunodeficiencies.

Reference

1. Rukasin C, et al. Poster 298. High drug allergy label burden for children with primary immunodeficiencies. Presented at American Academy of Allergy, Asthma & Immunology Annual Meeting; Feb. 27-March 2, 2026; Philadelphia.