1740. Antibiotic Allergy Delabeling in Pediatric Infectious Disease Clinic: Missed Stewardship Opportunities

Abstract

Abstract Background Reported beta lactam antibiotic allergies are common, with up to 10% of individuals carrying a penicillin [PCN] allergy label and approximately 1% carrying a cephalosporin allergy label. However, >90% of patients with a PCN allergy label can safely tolerate penicillins. Incorrect antibiotic allergy label can contribute to increases in antibiotic resistance and medication side effects. Appropriate medication allergy history taking is necessary and sometimes sufficient to effectively remove inappropriate allergy labels. We aimed to evaluate opportunities for addressing inappropriate PCN allergy labels in a pediatric infectious diseases clinic. Methods Electronic medical records (EMRs) for patients seen in an academic outpatient pediatric infectious diseases clinic from January 1, 2021 through April 30, 2021 were reviewed for presence of documented antibiotic allergy at time of visit, antibiotic class (PCN, cephalosporin [Ceph.], or non-beta lactam), reaction type, documentation of full reaction history needed to stratify for potential delabeling, and whether or not potential allergy delabeling was addressed during the visit. Results Antibiotic allergy labels were present in the EMR in 18% (n=16) of the 90 encounters reviewed, representing 19% (n=15) of patients seen. Beta lactam antibiotic reactions accounted for 69% (11/16) of documented allergies; 8 PCN class (73%), 2 Ceph. class (18%), 1 with both PCN and Ceph. class allergy (9%). Reactions included rash (6 visits; 54%), hives (3; 27%), nausea/vomiting (1; 9%), diarrhea (1; 9%), swelling (1; 9%), and none recorded (2; 18%). [Sum >100% due to multiple reactions listed]. No additional reaction history was obtained for any patient during the visits. Antibiotic allergy delabeling or assessment by an allergist was only addressed during 1 of the 16 visits with documented antibiotic allergy (6.3%). Conclusion Antibiotic allergy labels are common in pediatric infectious diseases clinic patients. However, appropriate medication allergy histories and the potential for allergy delabeling were not documented for the majority of patients with antibiotic allergy labels. This represents a significant missed opportunity for antibiotic allergy delabeling and a target for future antimicrobial stewardship opportunities. Disclosures All Authors: No reported disclosures.