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Impact of Penicillin Allergy Label on Clinical Outcomes of Pneumonia in Children
Lauren W Kaminsky1, Sarah Al-Obaydi2, Rezhan H Hussein3
1Section of Allergy, Asthma and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, Pa.
Insights
Children with a penicillin (PCN) allergy label face higher risks of hospitalization and acute respiratory failure from pneumonia. Removing this label may reduce pneumonia-related illness in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Outcomes Research
- Allergy and Immunology
Background:
- Penicillin allergy labels affect approximately 5% of children, influencing antibiotic selection and hospital stay duration.
- The clinical impact of penicillin allergy labels on pediatric pneumonia outcomes remains under-characterized.
Purpose of the Study:
- To investigate the association between penicillin allergy labels and clinical outcomes in pediatric pneumonia patients.
- To compare hospitalization risk, intensive care needs, and acute respiratory failure in children with and without penicillin allergy labels.
Main Methods:
- A propensity score-matched cohort study utilizing the TriNetX research network.
- Comparison of 30-day risks for hospitalization, intensive care, and acute respiratory failure in pediatric pneumonia patients (aged 1-17 years) with and without penicillin allergy labels.
- Analysis of antibiotic prescription patterns and associated complications.
Main Results:
- Penicillin allergy labels were linked to increased hospitalization (RR 1.15), acute respiratory failure (RR 1.27), and intensive care (RR 1.46).
- Patients with penicillin allergy labels received broader-spectrum antibiotics, leading to higher rates of cutaneous drug reactions (RR 2.43) and Clostridioides difficile infection (RR 2.25).
Conclusions:
- Pediatric patients with penicillin allergy labels experience worse pneumonia outcomes, including higher hospitalization and complication rates.
- Re-evaluating and potentially removing penicillin allergy labels could mitigate morbidity associated with pediatric pneumonia.
Background:
Penicillin (PCN) allergy label, reported in approximately 5% of children, influences antibiotic choice and prolongs hospital stay. To our knowledge, the impact of PCN allergy label on clinical outcomes of pneumonia in children is not well characterized.
Objectives:
To investigate the impact of PCN allergy label on clinical outcomes of pneumonia in children.
Methods:
In this propensity score-matched cohort study, we used the TriNetX research network, a population-based database, to compare the 30-day risk of hospitalization, need for intensive level of care, and acute respiratory failure from pneumonia between pediatric patients (aged 1-17 years) with and without a PCN allergy label after matching the 2 cohorts for demographic and medical comorbidities. Antibiotic prescription patterns were also contrasted.
Results:
When comparing 3793 pediatric patients with pneumonia labeled with a PCN allergy with matched children without a PCN allergy label, PCN allergy label was associated with a higher risk of hospitalization (relative risk [RR], 1.15; 95% confidence interval [CI], 1.07-1.23), acute respiratory failure (RR, 1.27; 95% CI, 1.17-1.39), and need for intensive level of care (RR, 1.46; 95% CI, 1.15-1.84). PCN allergy label resulted in overutilization of broader-spectrum antibiotics and increased complications including cutaneous drug reactions (RR, 2.43; 95% CI, 1.31-4.52) and Clostridioides difficile infection (RR, 2.25; 95% CI, 1.14-4.44).
Conclusion:
Children with a PCN allergy label are more likely to be hospitalized, receive broader-spectrum antibiotics, and develop acute respiratory failure from pneumonia. Delabeling may offer a way to lessen morbidity from pneumonia in children.
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