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Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms
David Vyles1, Juan Adams2, Asriani Chiu2
1Pediatric Emergency Medicine, dvyles@mcw.edu.
Insights
A low-risk penicillin allergy questionnaire accurately identified children without true penicillin allergy in a pediatric emergency department. This finding supports increased use of first-line penicillin antibiotics for low-risk patients.
Area of Science:
- Pediatric Emergency Medicine
- Allergy and Immunology
- Clinical Diagnostics
Background:
- Penicillin allergy is frequently reported in pediatric emergency departments, leading to avoidance of essential first-line antibiotics.
- True penicillin allergy is rare, yet its diagnosis often results in unnecessary antibiotic restrictions.
- This study addresses the diagnostic accuracy of a low-risk assessment for penicillin hypersensitivity in children.
Purpose of the Study:
- To evaluate the hypothesis that children with low-risk symptoms for immunoglobulin E-mediated hypersensitivity will test negative for true penicillin allergy.
- To assess the utility of a parent-completed allergy questionnaire for identifying low-risk pediatric patients.
- To determine the rate of true penicillin allergy among children with low-risk reported symptoms.
Main Methods:
- Parents of children aged 4–18 years with reported penicillin allergy completed a questionnaire.
- A cohort of 100 children with low-risk symptoms underwent standardized 3-tier penicillin allergy testing.
- The percentage of children with negative allergy test results and 95% confidence intervals were calculated.
Main Results:
- Of 597 parents surveyed, 302 children had low-risk symptoms. 100 eligible children underwent testing.
- The most common symptoms reported were rash (97%) and itching (63%).
- All 100 tested children (100%; 95% CI 96.4%-100%) had negative penicillin allergy test results, leading to removal of the allergy label.
Conclusions:
- A low-risk penicillin allergy questionnaire effectively identified children without true penicillin allergy.
- Utilizing this questionnaire in pediatric emergency departments can facilitate the appropriate use of first-line penicillin antibiotics.
- Negative testing in low-risk children supports de-labeling penicillin allergy and optimizing antibiotic selection.
Background:
Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics. We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin allergy.
Methods:
Parents of children aged 4 to 18 years old presenting to the pediatric ED with a history of parent-reported penicillin allergy completed an allergy questionnaire. A prespecified 100 children categorized as low-risk on the basis of reported symptoms completed penicillin allergy testing by using a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval.
Results:
Five hundred ninety-seven parents completed the questionnaire describing their child's reported allergy symptoms. Three hundred two (51%) children had low-risk symptoms and were eligible for testing. Of those, 100 children were tested for penicillin allergy. The median (interquartile range) age at testing was 9 years (5-12). The median (interquartile range) age at allergy diagnosis was 1 year (9 months-3 years). Rash (97 [97%]) and itching (63 [63%]) were the most commonly reported allergy symptoms. Overall, 100 children (100%; 95% confidence interval 96.4%-100%) were found to have negative results for penicillin allergy and had their labeled penicillin allergy removed from their medical record.
Conclusions:
All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics.
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