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Parental perspective on penicillin allergy delabeling in a pediatric emergency department
Cheryl Yang1, Jessica K Graham2, David Vyles3
1Pediatric Emergency Medicine, Primary Children's Hospital, Salt Lake City, Utah.
Insights
Most parents are hesitant about penicillin allergy delabeling in children due to fear of reactions. Addressing these concerns and educating on antibiotic alternatives is crucial for successful penicillin allergy delabeling in pediatric emergency departments.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pediatrics
- Emergency Medicine
Background:
- Penicillin (PCN) allergy is often misdiagnosed in children, leading to unnecessary avoidance of this crucial antibiotic.
- Successful penicillin allergy delabeling in pediatric emergency departments (PEDs) hinges on parental understanding and consent.
- Accurate identification of low-risk children is essential for effective delabeling strategies.
Purpose of the Study:
- To explore parental perspectives on allergy delabeling in the PED for children identified as low risk for true penicillin allergy.
- To identify facilitators and barriers to penicillin allergy delabeling in a pediatric emergency setting.
Main Methods:
- A cross-sectional survey was conducted with parents of children with documented penicillin allergy in a tertiary-care PED.
- Parents completed a questionnaire to stratify their child's risk for true penicillin allergy.
- For low-risk children, parents assessed facilitators and barriers to oral challenge and delabeling.
Main Results:
- Of 198 children, 49 (25%) screened low risk for penicillin allergy.
- A majority of parents (59%) of low-risk children were uncomfortable with a PED-based penicillin oral challenge, citing fear of reaction (72%) and availability of alternatives (45%).
- Willingness to delabel was associated with perceived low adverse effects of penicillin (65%) and avoiding antimicrobial resistance (74%). Parents without a family history of penicillin allergy were more amenable to oral challenge and delabeling.
Conclusions:
- Many parents are hesitant regarding penicillin allergy oral challenges and delabeling in the PED for their children.
- Educating parents on the safety of oral challenges for low-risk children and the benefits/risks of alternative antibiotics is recommended.
- The minimal impact of family history on penicillin allergy risk should be emphasized to improve parental comfort with delabeling.
Background:
Penicillin (PCN) allergy is frequently mislabeled and inaccurately diagnosed in children. Successful implementation of pediatric emergency department (PED) delabeling efforts requires parental understanding and willingness for children to be delabeled as PCN-nonallergic.
Objective:
To describe the parental perspective on allergy delabeling in the PED for children identified as low risk for true PCN allergy.
Methods:
This is a cross-sectional survey of parents of children with documented PCN allergy presenting to a single tertiary-care PED. Parents were first approached to complete a PCN allergy identification questionnaire to stratify their child as high- or low-risk for true PCN allergy. Facilitators and barriers to PED-based oral challenge and delabeling were subsequently assessed by parents of low-risk children.
Results:
A total of 198 participants completed the PCN identification questionnaire. Of 198 children, 49 (25%) screened low risk for true PCN allergy. Of the 49 low-risk children, 29 (59%) parents were uncomfortable with a PED-based PCN oral challenge. Reasons include fear of allergic reaction (72%), availability of adequate alternative antibiotics (45%), and longer PED stay (17%). Reasons for willingness to delabel included PCN's low adverse effect profile (65%) and avoidance of antimicrobial resistance from alternative antibiotics (74%). Participants without a family history (FH) of PCN allergy were more comfortable with PED-based PCN oral challenge (60% vs 11%; P = .001) and delabeling (67% vs 37%; P = .04) compared with those with FH.
Conclusion:
Most parents of children with low-risk PCN allergy are uncomfortable with oral challenge or delabeling in the PED. Before implementing oral challenges in PEDs, efforts should be made to highlight the safety of oral challenging low-risk children, the benefits and risks of alternative antibiotics, and the minimal impact that FH has on PCN allergy.
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