Drug Allergy Labels Rarely Evaluated for Children with Primary Immunodeficiencies

Only 20 participants received a formal drug allergy evaluation which resulted in the delabeling of 17 drug allergy labels

MILWAUKEE, Feb. 13, 2026 /PRNewswire/ -- Drug allergy labels (DAL) are common and largely unevaluated in children with primary immunodeficiencies, which could lead to worse patient outcomes, according to new research being presented at the 2026 AAAAI Annual Meeting.

"Drug reactions can be scary for families, particularly for children with primary immunodeficiencies who have a higher need for antibiotics. Many children in this population carry antibiotic allergy labels, and of those who underwent formal evaluation the majority were delabeled," said author Christine R. Rukasin, MD, FAAAAI, allergist and immunologist at Phoenix Children's. "This research reinforces the importance of drug allergy evaluation to remove unnecessary and unconfirmed drug allergy labels, support safe and effective antibiotic use and make a meaningful difference in pediatric care."

The researchers suggest that treatment plans for patients with primary immunodeficiencies often involve antibiotics and DAL may lead to worse health outcomes, longer hospital stays, higher readmission rates and exposure to second-line broader spectrum antibiotics, highlighting the importance of allergy label evaluation for patients at risk for antibiotic needs.

In this retrospective chart review of patients with immunodeficiency seen at Phoenix Children's between January 2022 and March 2025, researchers collected data involving demographics, primary immunodeficiency diagnoses, DAL, reactions information, results of drug allergy evaluation and antibiotic use to explore the effects of drug allergy labels on patient health outcomes.

A total of 219 patients, 57% of which were male, with a median age of 10 years old, met the inclusion criteria for the study. According to the research, 59.8% of participants self-reported as White, 21.4% reported as Hispanic or Latino and 7.7% as American Indian. Of those participants, 48.4% had one or more DAL. Out of the 226 total examined DALs, 43.4% involved antibiotics, with penicillin being the most prevalent at 16.4%, cephalosporins at 8.0%, vancomycin at 6.6% and trimethoprim/sulfamethoxazole at only 4.0% of the represented DALs. Of the patients with a DAL, only 20 out of 106 (18.9%) received a formal evaluation with an allergist/immunologist, which resulted in the delabeling of 17 DALs. Approximately 20% of patients were on prophylactic antibiotics, including 10.5% on azithromycin and 8.2% on trimethoprim/sulfamethoxazole. 

Visit aaaai.org to learn more about penicillin allergy delabeling. Research presented at the 2026 AAAAI Annual Meeting, February 27 – March 2 in Philadelphia, PA, is published in an online supplement to The Journal of Allergy and Clinical Immunology (JACI).

The American Academy of Allergy, Asthma & Immunology (AAAAI) is the leading membership organization of more than 7,100 allergists, asthma specialists, clinical immunologists and other professionals with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI is the go-to resource for patients living with allergies, asthma and immune deficiency disorders.

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SOURCE American Academy of Allergy, Asthma & Immunology (AAAAI)