An eight-year-old boy who one month ago presented at the emergency room due to hives. The hives developed a few days after treatment with amoxicillin for an ear infection. This was his first exposure to amoxicillin. The symptoms lasted a few days. There was no involvement of mucosal membranes and he presented with no respiratory, gastrointestinal or cardiovascular symptoms.

A graded challenge to amoxicllin was positive 5 hours later. He developed flushing, itchiness and swelling mainly of his limbs and face that lasted 3 days (Figure 1 and 2). Complete blood count, liver enzymes, C-reactive protein, sedimentation rate , creatinin and C3 , C4 levels taken during his reaction were within the normal limits for his age. This an example of a non-immediate likely T cell mediated reaction to amoxicillin

Figure 1: T Cell Mediated Reaction to Amoxicillin

Figure 2: Flushing, itchiness and swelling in hand