The following is the summary of “Distinct Characteristics and Chronology of Amoxicillin-Associated Reactions in Pediatric Acute Care Settings” published in the November 2022 issue of Allergy and Clinical Immunology by Guarnieri, et al.

According to current evidence, most children who experience an amoxicillin-associated reactions (AAR) will eventually develop a tolerance to the drug. However, more information is needed before pediatricians and allergists can feel comfortable referring and testing children who exhibit “worrisome” systemic symptoms that warrant immediate medical attention. Researchers want to improve our diagnostic prowess to better direct future allergy examinations by defining the full range of AAR symptoms in children who presented to the emergency department (ED)/urgent care (UC).

Determine the spectrum of rash and systemic symptoms experienced by children with AARs who visit the ED/UC. Children’s records from the ED/UC between July 1, 2015, and June 30, 2017 were reviewed retrospectively. Cases were reported in terms of their clinical presentation, timing, and seasonality, and if they had joint symptoms, they were categorized into 1 of 3 AAR phenotypes: maculopapular exanthem (MPE), urticaria, or serum sickness-like responses (SSLRs). On days 7-10 of amoxicillin, the majority of the children (n=668; median age: 1.8 years) who experienced urticaria (44%), MPE (36%), and SSLRs (11%) presented to the ED/UC.

Delayed-onset systemic symptoms were observed frequently in all 3 groups, but children with SSLRs had a greater proportion of “worrisome” features (fever, angioedema, or gastrointestinal symptoms; 73%, P<.0001) and were more likely to be treated with corticosteroids (28%, P<.0001). Surprisingly high re-visitation rates to the ED/UC for re-evaluation were seen, with 66 children (10%) doing so. Children with AARs who present to the ED/UC often exhibit “worrisome” symptoms. The effect on later referral and allergy testing is unclear and will require further research.

Source: sciencedirect.com/science/article/abs/pii/S2213219822006997