Atanaskovic-Markovic, Marina (6506020842)Marina (6506020842)Atanaskovic-MarkovicGaeta, Francesco (7006703533)Francesco (7006703533)GaetaMedjo, Biljana (33467923300)Biljana (33467923300)MedjoGavrovic-Jankulovic, Marija (6603098036)Marija (6603098036)Gavrovic-JankulovicCirkovic Velickovic, Tanja (57201156470)Tanja (57201156470)Cirkovic VelickovicTmusic, Vladimir (57189214734)Vladimir (57189214734)TmusicRomano, Antonino (7201571602)Antonino (7201571602)Romano2025-06-122025-06-122016https://doi.org/10.1111/pai.12565https://www.scopus.com/inward/record.uri?eid=2-s2.0-84978264083&doi=10.1111%2fpai.12565&partnerID=40&md5=03401ae69d83ed843b692da0e318cbeehttps://remedy.med.bg.ac.rs/handle/123456789/7618Background: Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as ‘drug allergic’ after considering only the clinical history. Objective: To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL. Methods: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs). In 300 children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae. Results: Urticaria and maculopapular exanthemas were the most reported non-immediate reactions. Only 76 (7.4%) of 1026 children had confirmed non-immediate hypersensitivity reactions to BL. Fifty-seven children had positive delayed-reading intradermal tests (18 of these with a positive patch test). Nineteen children had positive DPT. Sixty-six of 300 children had positive tests for viruses or Mycoplasma pneumoniae and 2 of them had a positive allergy work-up. Conclusions: A diagnostic work-up should be performed in all children with non-immediate reactions to BL, to remove a false label of hypersensitivity. Even though only 57 (5.5%) of 1026 children displayed positive responses to delayed-reading intradermal tests to BL, such tests appear to be useful in order to reduce the risk for positive DPTs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltdallergy work-upbeta-lactamschildrennon-immediate hypersensitivity reactionsprovocation testskin test