Breaking the Mold: Safely Delabeling Penicillin Allergies in Hospitalized Children.

Abstract

Children are often reported to have antibiotics allergies, with up to 35 million people, or 10% of the US population, labeled as allergic to an antibiotic.1 In fact, 75% of children with reported antibiotic allergies are identified before the age of 3 years.2 Recent studies have revealed that the majority of symptoms reported as an allergy by parents are non–immunoglobulin E–mediated adverse reactions or symptoms of a viral illness, such as rash, abdominal pain, vomiting, diarrhea, or other benign symptoms.3,4 Additionally, >90% of patients with a reported penicillin allergy have negative skin testing results.1,5,6 Several studies in adults and children reveal risk-stratified management, wherein those at low risk for a true allergy skip skin testing in favor of direct oral challenge, is safe and effective.7 Delabeling penicillin allergies in children without true allergies is critical because penicillin allergy labels are associated with worse clinical outcomes, increased adverse drug events, more multidrug-resistant infections, and increased health care costs.7–9 Although risk-stratified management of drug allergies is now standard of care,7,8 implementation of this best practice in the hospital setting is lacking. In this issue of Hospital Pediatrics , researchers report a single-center, hospital-based quality improvement (QI) project aimed at performing risk stratification of penicillin allergies, with subsequent delabeling of children who do …