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Health outcomes of penicillin allergy testing in children: a systematic review
Mo Kwok1,2, Katie L Heard3, Anthony May1,2
1Department of Pharmacy, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Insights
Penicillin allergy testing (PAT) in children often leads to successful delabeling, with most tolerating subsequent penicillin courses. However, long-term impacts on disease burden require further investigation.
Area of Science:
- Pediatric Allergy and Immunology
- Antimicrobial Stewardship
- Clinical Outcomes Research
Background:
- Penicillin allergy labels acquired in childhood frequently result in unnecessary avoidance of first-line antibiotics.
- Understanding the health outcomes of penicillin allergy testing (PAT) is crucial for effective antimicrobial stewardship.
- This review focuses on the health outcomes of PAT in pediatric populations.
Approach:
- A systematic literature search was conducted across major databases (Embase, MEDLINE, Web of Science, Cochrane Library, SCOPUS, CINAHL) up to October 2021.
- Included studies involved in vivo PAT in children (≤18 years) and reported relevant health outcomes.
- Thirty-seven studies encompassing 8411 participants were analyzed.
Key Points:
- The most frequently reported outcomes were successful delabeling, subsequent penicillin use, and tolerability.
- A high median of 93.6% of children tolerated subsequent penicillin courses after negative PAT.
- While many children were reported as delabeled (median 97.3%), verified delabeling rates in medical records ranged from 48.0% to 68.3%.
Conclusions:
- Existing literature primarily addresses the safety and efficacy of PAT and subsequent penicillin use.
- Further research is needed to evaluate the long-term effects of penicillin allergy delabeling on disease burden, including antibiotic resistance and infection rates.
Background:
Penicillin allergy labels are commonly acquired in childhood and lead to avoidance of first-line penicillin antibiotics. Understanding the health outcomes of penicillin allergy testing (PAT) can strengthen its place in antimicrobial stewardship efforts.
Objectives:
To identify and summarize the health outcomes of PAT in children.
Methods:
Embase, MEDLINE, Web of Science, Cochrane Library, SCOPUS and CINAHL were searched from inception to 11 Oct 2021 (Embase and MEDLINE updated April 2022). Studies that utilized in vivo PAT in children (≤18 years old) and reported outcomes relevant to the study objectives were included.
Results:
Thirty-seven studies were included in the review, with a total of 8411 participants. The most commonly reported outcomes were delabelling, subsequent penicillin courses, and tolerability to penicillin courses. Ten studies had patient-reported tolerability to subsequent penicillin use, with a median 93.6% (IQR 90.3%-97.8%) of children tolerating a subsequent course of penicillins. In eight studies, a median 97.3% (IQR 96.4%-99.0%) of children were reported as 'delabelled' after a negative PAT without further definition. Three separate studies verified delabelling by checking electronic or primary care medical records, where 48.0%-68.3% children were delabelled. No studies reported on outcomes relating to disease burden such as antibiotic resistance, mortality, infection rates or cure rates.
Conclusions:
Safety and efficacy of PAT and subsequent penicillin use was the focus of existing literature. Further research is required to determine the long-term impact of delabelling penicillin allergies on disease burden.
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