Fecha de publicación: -- Fuente: PubMed "hive" Pediatr Allergy Immunol. 2026 Nov;37(11):e70542. doi: 10.1111/pai.70542.ABSTRACTBACKGROUND: De-labeling suspected adverse drug hypersensitivity reactions (DHRs) is a critical goal in clinical practice, as misdiagnosed allergies lead to unnecessary medicalization and unwarranted restrictions on available medications. In children, high-risk factors for DHRs, such as immediate urticaria, often overlap with common viral rashes, complicating risk stratification. This challenge is compounded by caregiver-reported histories, which can distort symptom timing and severity. This cross-sectional comparative questionnaire study with a comparison group evaluated how caregivers and pediatric patients visually recognize common drug-related skin eruptions and whether non-clinical variables may affect recognition accuracy.METHODS: Patients and caregivers referred to the Allergy Units of two tertiary care hospitals for suspected DHRs were included. Questionnaires were offered to caregivers and patients aged 7-17. Participants were divided into two groups: patients with suspected DHRs and subjects without a history of DHRs. Enrolled subjects were asked to recognize pictures of maculopapular, micropapular, and urticaria via a multiple-choice questionnaire.RESULTS: Data from 405 participants were collected between September 2023 and August 2024. Statistical analysis showed that higher caregiver education and a positive personal history of DHRs and/or urticaria significantly improved recognition accuracy. Nevertheless, nearly half of participants with suspected DHR history misidentified urticaria as micropapular rash. Rash recognition skills did not differ significantly between healthcare and non-healthcare caregivers.CONCLUSION: These findings highlight the need for systematic approaches beyond descriptive histories. Integrating non-clinical factors into diagnostic frameworks could enhance risk stratification and support safer and more effective allergy workup for de-labeling suspected DHRs in pediatric patients.PMID:42973278 | DOI:10.1111/pai.70542