Visual bias in the clinical history of pediatric cutaneous drug hypersensitivity reactions.

Authors

Giacomo Gagliardi, Leonardo Tomei, Giulia Liccioli, Simona Barni, Mattia Giovannini, Lucrezia Sarti, Benedetta Pessina, Erika Paladini, Anna Ariano, Salvatore Grosso, Francesca Mori

Published in

Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. Volume 37. Issue 11.

Abstract

De-labeling suspected adverse drug hypersensitivity reactions (DHRs) is a critical goal in clinical practice, as misdiagnosed allergies lead to unnecessary medicalization and unwarranted restrictions on available medications. In children, high-risk factors for DHRs, such as immediate urticaria, often overlap with common viral rashes, complicating risk stratification. This challenge is compounded by caregiver-reported histories, which can distort symptom timing and severity. This cross-sectional comparative questionnaire study with a comparison group evaluated how caregivers and pediatric patients visually recognize common drug-related skin eruptions and whether non-clinical variables may affect recognition accuracy.
Patients and caregivers referred to the Allergy Units of two tertiary care hospitals for suspected DHRs were included. Questionnaires were offered to caregivers and patients aged 7-17. Participants were divided into two groups: patients with suspected DHRs and subjects without a history of DHRs. Enrolled subjects were asked to recognize pictures of maculopapular, micropapular, and urticaria via a multiple-choice questionnaire.
Data from 405 participants were collected between September 2023 and August 2024. Statistical analysis showed that higher caregiver education and a positive personal history of DHRs and/or urticaria significantly improved recognition accuracy. Nevertheless, nearly half of participants with suspected DHR history misidentified urticaria as micropapular rash. Rash recognition skills did not differ significantly between healthcare and non-healthcare caregivers.
These findings highlight the need for systematic approaches beyond descriptive histories. Integrating non-clinical factors into diagnostic frameworks could enhance risk stratification and support safer and more effective allergy workup for de-labeling suspected DHRs in pediatric patients.

PMID:
42973278
Bibliographic data and abstract were imported from PubMed on 03 Nov 2026.

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