Beta-Lactam Allergy De-labeling in a Pediatric Hospital

Area of Science:

• Allergy and Immunology
• Pediatric Medicine
• Clinical Protocol Implementation

Background:

• Beta-lactam antibiotics are frequently associated with reported allergies in pediatric populations.
• Accurate allergy assessment is crucial to avoid unnecessary avoidance of beta-lactam antibiotics, which can lead to broader-spectrum antibiotic use.
• Implementing standardized protocols can improve the accuracy of allergy de-labeling.

Purpose of the Study:

• To evaluate the effectiveness of a new institutional protocol for de-labeling beta-lactam allergies in pediatric patients.
• To identify barriers encountered during the beta-lactam allergy de-labeling process.

Main Methods:

• A beta-lactam allergy interview was conducted for eligible pediatric patients.
• Patients were risk-stratified (no, low, moderate, high risk) post-interview.
• Interventions included de-labeling based on interview alone or oral amoxicillin challenge, with or without penicillin allergy skin testing.

Main Results:

• 40% (25/62) of eligible pediatric patients were successfully de-labeled.
• 60% (15/25) of de-labeled patients were identified through interview alone.
• No adverse events were reported in patients undergoing oral amoxicillin challenge or skin testing.

Conclusions:

• A high rate of successful beta-lactam allergy de-labeling was achieved using the new protocol.
• Barriers such as antihistamine/steroid use, patient refusal, and resource limitations impede the de-labeling process.
• Enhanced education and increased staffing for de-labeling interventions are recommended to improve outcomes.