{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:28:39Z","timestamp":1777984119641,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Beta\u2010lactam antibiotics remain the most commonly reported cause of drug allergy in children. Skin testing often shows limited sensitivity and logistical challenges, particularly for non\u2010immediate reactions, leading to the adoption of risk\u2010stratified diagnostic algorithms. This retrospective study evaluated the safety and diagnostic performance of a risk\u2010stratified approach in children with suspected beta\u2010lactam hypersensitivity, focusing on low\u2010risk non\u2010immediate phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medical records of 180 children (aged 3\u201318\u2009years) evaluated for suspected beta\u2010lactam allergy were reviewed. Patients were stratified based on reaction timing and clinical phenotype. Moderate\u2010to\u2010high\u2010risk cases (history of anaphylaxis or immediate reactions) underwent skin testing followed by drug provocation test (DPT) if skin tests were negative. Low\u2010risk cases (mild maculopapular exanthema [MPE] or benign delayed\u2010onset urticaria occurring &gt;6\u2009h after dosing and lasting &gt;24\u2009h) underwent direct oral DPT without prior skin testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Beta\u2010lactam hypersensitivity was confirmed in 15.6% (28\/180) of patients, with higher confirmation rates in immediate reactions (21.1%) compared to non\u2010immediate reactions (3.5%). Among 57 low\u2010risk non\u2010immediate patients who underwent direct DPT, only 2 (3.5%) experienced mild, self\u2010resolving cutaneous reactions; no systemic or severe reactions were observed. No positive reactions occurred in patients with delayed\u2010onset urticaria (&gt;6\u2009h post\u2010dose).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Risk stratification based on detailed clinical history provides a safe and effective strategy for evaluating suspected beta\u2010lactam hypersensitivity in children. Direct oral DPT without preceding skin testing is safe and efficient for low\u2010risk non\u2010immediate phenotypes, including mild MPE and benign delayed\u2010onset urticaria, and should be more widely implemented to facilitate timely delabeling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pai.70327","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:23:00Z","timestamp":1775100180000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct drug provocation testing for the diagnosis of low\u2010risk pediatric beta\u2010lactam allergy: A risk\u2010stratified retrospective study"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2489-4021","authenticated-orcid":false,"given":"\u00d6zlem","family":"Sancakl\u0131","sequence":"first","affiliation":[{"name":"Division of Pediatric Allergy and Immunology University of Health Sciences, \u0130zmir Dr. Beh\u00e7et Uz Children's Hospital  \u0130zmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soner","family":"G\u00fcnder","sequence":"additional","affiliation":[{"name":"Division of Pediatric Allergy and Immunology University of Health Sciences, \u0130zmir Dr. Beh\u00e7et Uz Children's Hospital  \u0130zmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aymen","family":"Hi\u015fmio\u011fullar\u0131","sequence":"additional","affiliation":[{"name":"Division of Pediatric Allergy and Immunology University of Health Sciences, \u0130zmir Dr. Beh\u00e7et Uz Children's Hospital  \u0130zmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-4117","authenticated-orcid":false,"given":"Figen \u00c7elebi","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"Division of Pediatric Allergy and Immunology University of Health Sciences, \u0130zmir Dr. Beh\u00e7et Uz 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