Introduction: Studies specifically focusing on drug-induced anaphylaxis (DIA) in children are few. There is no study comparing inpatient (IP) and outpatient (OP) settings in DIA, either in children or in adults. We aimed to compare the characteristics of pediatric DIAs observed in IP and OP settings. Methods: Patients aged ≤18 years who were diagnosed with DIA at our institution over the past 15 years were included in the study. The diagnosis of DIA was made clinically, and diagnostic testing were performed in eligible patients. Patients were categorized as IP and OP groups based on the settings in which DIA occurred. Results: A total of 162 pediatric DIAs (55% IP vs. 45% OP) were reviewed. The most frequent triggering drugs were chemotherapeutics, enzyme replacement therapies for metabolic disorders, and antibiotics in IP group, and NSAIDs, antibiotics, and local anesthetics in OP group. Parenteral drug use was more frequent in IP group (p<0.001). Age at DIA, time to DIA, and severity of DIA were similar between the two groups. However, after excluding parenteral drugs from OP group, significant differences in all three parameters were seen in IP group (p<0.05 for each). Patients in IP group had more non-allergic chronic comorbidities and gastrointestinal symptoms, while OP group showed higher rates of asthma, allergic rhinitis, and acute infections as co-factors (p≤0.001 for each). Antihistamine and systemic corticosteroid use was higher in OP group (p<0.05 for each), but the use of IM adrenaline was similar in both groups. Conclusion: Triggering drugs, clinical presentations, management, chronic allergic and non-allergic comorbidities, and co-factors in pediatric DIA differ between the two groups. Contrary to expectations, the setting did not affect the onset or severity of DIA, likely due to the higher frequency of parenteral drug administration in OP settings.
Koken et al. (2026) studied this question.