Nearly Half of Kids With Immunodeficiency Carry Incorrect Drug Allergy Labels

Allergy testing often finds no true allergy, opening up treatment options, but few children undergo evaluation.

Mar. 3, 2026 at 1:55am

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A study of 219 children with primary immunodeficiencies found that nearly half (48.4%) carried at least one drug allergy label, with antibiotics being the most common culprit. However, when allergy testing was conducted, 17 out of 20 labels were successfully 'delabeled', suggesting a significant opportunity to expand treatment options for this vulnerable population. The research highlights the need for increased referrals to allergists for comprehensive evaluation, as only 18.9% of children with a drug allergy label underwent testing.

Why it matters

Incorrect drug allergy labels can lead to the use of less effective, broader-spectrum antibiotics, potentially prolonging hospital stays, increasing readmission rates, and worsening patient outcomes for children with primary immunodeficiencies who require frequent antibiotic treatment. Delabeling through allergy testing can unlock access to crucial medications and improve care.

The details

The retrospective chart review found that of the 226 total drug allergy labels, 43.4% involved antibiotics, with penicillin (16.4%), cephalosporins (8%), vancomycin (6.6%) and trimethoprim/sulfamethoxazole (4%) being the most common. When 20 of these labels were evaluated by an allergist, 17 were successfully delabeled, suggesting a high rate of incorrect allergy designations. However, the study also revealed that only 18.9% of children with a drug allergy label had actually undergone allergy testing.

  • The study was presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting in 2026.

The players

Dr. Christine Rukasin

An allergist and clinical immunologist at Phoenix Children's Hospital who emphasizes the need for increased referrals to allergists to evaluate drug allergy labels in children with primary immunodeficiencies.

Phoenix Children's Hospital

A children's hospital in Phoenix, Arizona that has a well-established drug allergy program and is exploring ways to broaden its impact through multidisciplinary collaboration.

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What they’re saying

“If they don't have access to the most effective antibiotics, this may lead to less optimal treatment.”

— Dr. Christine Rukasin, Allergist and clinical immunologist

“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.”

— Dr. Christine Rukasin, Allergist and clinical immunologist

What’s next

Phoenix Children's Hospital is actively exploring ways to streamline referral processes and raise awareness among healthcare providers about the benefits of allergy testing for children with primary immunodeficiencies.

The takeaway

This study highlights the significant opportunity to improve treatment options for children with primary immunodeficiencies by delabeling incorrect drug allergy designations through comprehensive allergy testing, which can unlock access to crucial medications and lead to better patient outcomes.