Children with reported penicillin allergy: Public health impact and safety of delabeling

David Vyles 1, James W Antoon 2, Allison Norton 3, Cosby A Stone Jr 3, Jason Trubiano 4, Alexandra Radowicz 5, Elizabeth J Phillips 6

Affiliations

PMID: 32224207
PMCID: PMC7255916
DOI: 10.1016/j.anai.2020.03.012

Free PMC article

Abstract

Objective: To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children.

Data sources: Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review.

Study selections: Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label.

Results: This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy.

Conclusion: Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.