Related Experiment Video
Updated: May 6, 2026
Application of Biochip Microfluidic Technology to Detect Serum Allergen-specific Immunoglobulin E sIgE
Published on: April 21, 2019
Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study
Jacqueline Wong1,2,3, Adelle Atkinson4,5, Kathryn Timberlake6
1Division of Infectious Diseases, McMaster Children's Hospital, Hamilton, Ontario, Canada wongj37@mcmaster.ca.
Insights
A new antimicrobial stewardship programme successfully de-labelled beta-lactam allergies in paediatric patients using oral provocation tests (OPTs). This approach is feasible and safe, improving antibiotic selection for inpatients.
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Pharmacology
Background:
- Beta-lactam antibiotics are crucial, but inaccurate allergy labels limit their use.
- Antimicrobial stewardship programmes aim to optimize antibiotic use and reduce resistance.
- De-labelling inappropriate beta-lactam allergies can improve patient outcomes and antibiotic stewardship.
Purpose of the Study:
- To assess the implementation of an antimicrobial stewardship programme-led initiative for de-labelling beta-lactam allergies in hospitalized children.
- To evaluate the safety and feasibility of using direct oral provocation tests (OPTs) in this process.
Main Methods:
- A one-year quality improvement study with a before-after design was conducted in a tertiary care pediatric hospital.
- Patients with reported beta-lactam allergies underwent standardized assessment and risk stratification.
- Low-risk patients were offered an oral provocation test (OPT); de-labelling occurred if the history was non-allergic or after a successful OPT.
Main Results:
- Eighty patients with 85 reported beta-lactam allergies were assessed; 40% were ineligible for OPT.
- Of 40 eligible patients, 70% were de-labelled by history or successful OPT.
- De-labelling enabled 11% more patients to receive preferred beta-lactams, with 46% de-labelled overall.
Conclusions:
- An antimicrobial stewardship programme-led de-labelling programme utilizing direct OPTs is feasible and safe for pediatric inpatients.
- This strategy effectively removes inappropriate beta-lactam allergy labels, enhancing antibiotic selection.
- The findings support broader implementation in pediatric inpatient settings.
Objective:
To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).
Design:
One-year quality improvement study using a before-after design.
Setting:
Free-standing tertiary care paediatric hospital.
Patients:
Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit.
Interventions:
Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT.
Main Outcome Measures:
Removal of inappropriate beta-lactam allergy labels.
Results:
80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8-12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy (n=25, 29%). Reported reactions were primarily dermatological (n=65, 77%). Half of participants (n=40) were ineligible for OPT, with equal proportions due to clinical reasons or the nature of the reported reaction. Of the 40 eligible patients, 28 patients (70%) were de-labelled either by history alone (n=10) or OPT (n=18). All OPTs were successful. De-labelling allowed five additional patients (11% of those receiving antibiotics) to receive the preferred beta-lactam. Including patients who were subsequently assessed in the allergy clinic, almost half of all evaluated patients were de-labelled (n=37, 46%).
Conclusions:
An antimicrobial stewardship programme-led programme using a direct OPT was feasible and safe for expanding beta-lactam allergy de-labelling to paediatric patients admitted to the paediatric medicine inpatient unit.
Related Concept Videos
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Automated Microbial Diagnostics