Studies have demonstrated that penicillin allergy labels negatively impact patients and their families due to the use of alternative agents that may be less effective, more toxic, and more costly. As a result, penicillin allergy labels have become a target of antimicrobial stewardship programs to remove those labels. The 2022 American Academy of Allergy, Asthma, and Immunology guidelines recommend not performing skin testing and proceeding directly to oral penicillin challenges in children with a history of benign skin reactions.
A study was conducted to assess the safety of pediatric inpatient penicillin allergy delabeling by direct oral challenge for low-risk penicillin allergies in hospitalized inpatient at a children's medical center in the United States from Jan 1,2021, to June 27, 2023. In total, 1237 patients were admitted with a penicillin allergy label with a median age of 11.76 years. Among them, 648 patients reported an amoxicillin or penicillin allergy. The most reported allergic reactions were rash/hives (81.8%), itching (8.2%), and swelling (8.2%). 23 patients reported a family history as the reason for their allergy label, while 76 reported that their reactions were due to common side effects (i.e., nausea, diarrhea, or vomiting). On verbal consent, a single dose of amoxicillin or amoxicillin-clavulanate was administrated. Then, they were asked to stay for 1 hour to identify any immediate reactions. children excluded who used any medications that could impact an allergic response (e.g., antihistamines and steroids), or had symptoms that also occur in allergic reaction (e.g., rash, wheezing, and vomiting), or if they are younger than 2 years or has a development delay.
Direct oral penicillin challenges were completed in 96 patients admitted to acute care. Of the 96 patients admitted, 93 tolerated the direct oral penicillin challenge and were delabeled. One patient failed the challenge and two patients had delayed reactions.
The results of this study support the recommendation to perform direct oral penicillin challenge in pediatric patients and confirm that this challenge is safe and effective tool to delabel penicillin allergy labels in hospitalized pediatric patient with a low-risk penicillin allergy.
