Purpose of review <p>This review is aimed to update clinical allergists on recent international changes in classification, diagnosis, and management of pediatric drug allergy with a focus on antibiotics and NSAID allergy labels.</p> Recent findings <p> Guidelines have begun to standardize nomenclature, classification, and diagnostic approaches. In a progressive update, there is now a standard amoxicillin dose for direct provocation challenges, a defined severity scale for immediate reactors, and decreased threshold to drug provocation challenges for patients with serum sickness like reactions. Within antibiotic allergy label investigation, skin testing is being bypassed in favor of direct oral challenges performed in a single day without the use of extended challenges.</p> Summary <p> Continued investigation of the index reaction phenotypes, safety of drug challenges, and diagnostic certainty of in vitro studies will continue to advance the field of pediatric drug allergy. </p>