Annick Barbaud

1 Introduction Drug hypersensitivity reactions (DHR) include immediate (IDHR) and non-immediate (NIDHR). IDHR occurring within 6 h after the last drug dose and classically within 1 h after the first dose of a new therapeutic course may involve Immunoglobulin E (IgE)-mediated (type I) or non-IgE mediated mechanisms [1, 2].

BAT basophil activation test CGMP current good manufacturing practice CMC carboxymethylcellulose DHR drug hypersensitivity reaction DPT drug provocation test EAACI European Academy of Allergy and Clinical Immunology EDTA ethylenediaminetetraacetic acid EHR electronic health record EMA European Medicines Agency ENDA European Network for Drug Allergy FDA Food and Drug Administration GRADE Grading of Recommendations Assessment, Development and Evaluation IDT intradermal test IM intramuscular IV...

Hypersensitivity reactions to biologicals are increasingly reported; however, pediatric data on their immunopathogenesis, diagnosis, and management remain limited. This review summarizes the current evidence on clinical phenotypes, underlying mechanisms, and practical diagnostic and therapeutic strategies in children, highlighting the central role of allergy workup and tailored approaches such as premedication, drug provocation testing, and desensitization.