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Risk Stratification of Penicillin Allergy Labeled Children: A Cross-Sectional Study from Jordan
Jomana W Alsulaiman1, Khalid A Kheirallah2, Ahmad Alrawashdeh3
1Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Insights
Many children labeled with penicillin allergy in Jordan may not have true allergies. A survey indicated most reported reactions were low-risk, suggesting many cases could be de-labeled, improving antimicrobial stewardship.
Area of Science:
- Clinical Medicine
- Allergy and Immunology
- Pediatrics
Background:
- Penicillin allergy diagnosis in children is challenging, especially in resource-limited settings.
- This study aimed to assess the prevalence and characteristics of reported penicillin allergies in Jordanian children.
Purpose of the Study:
- To screen and risk-stratify children with a reported penicillin allergy history.
- To evaluate the clinical significance of reported penicillin reactions in a pediatric population.
Main Methods:
- A web-based survey was administered to parents of children with a penicillin allergy label.
- The survey collected data on reaction history, symptoms, severity, age of onset, and medical evaluations.
Main Results:
- 530 parents completed the survey; 86.4% reported reactions, 13.6% had no reaction history.
- 68.3% of reported reactions were low-risk symptoms (e.g., rash, cough), with skin rash being most common (86.0%).
- High-risk symptoms were reported in 31.5% of children; asthma comorbidity was higher in the high-risk group.
Conclusions:
- Many parent-reported penicillin allergic reactions in Jordan appear clinically insignificant and may not be verifiable.
- Accurate clinical history and evaluation are crucial for identifying true allergies and enabling de-labeling or further testing.
- Addressing mislabeled penicillin allergies can improve patient care and antimicrobial stewardship.
Background:
Implementing allergy testing among children with a reported history of penicillin allergy could be challenging, particularly in developing countries with limited resources. This study screened and risk-stratified the likelihood of true penicillin allergy among children labeled with penicillin allergy in Jordan.
Methods:
A web-based survey, completed by parents, assessed history, type, and severity of penicillin allergic reactions, including age at diagnosis, symptoms, time to the reaction, reaction's course and resolution, and received medical evaluation/testing. Low-risk allergic symptoms were defined as vomiting, diarrhea, headache, dizziness, itching, rash, cough, or runny nose without evidence of anaphylaxis or severe cutaneous reactions.
Results:
A total of 530 parents of "penicillin allergy"-labeled children completed the survey. Of these, 86.4% reported allergic reactions to penicillin and 13.6% reported avoidance of penicillin due to family history. Among the former, 52.2% were male, 67.3% were three years old or younger when the reported reaction was established, and 68.3% experienced exclusively low-risk symptoms. Overall, skin rash was the most reported symptom (86.0%). High-risk symptoms were reported in 31.5% of children. About two-thirds (64.0%) of children were reported to have experienced symptoms after the first exposure to penicillin. The most common indication for antibiotic use was a throat infection (63.8%). Asthma comorbidity was significantly higher among high-risk (24.8%) compared low-risk group (11.5%).
Conclusion:
In Jordan, many parent-reported penicillin allergic reactions seem to be clinically insignificant and unlikely to be verifiable, which can adversely affect patients' care and antimicrobial stewardship. An appropriate clinical history/evaluation is a key step in identifying true immunoglobulin E-mediated allergic reactions and risk stratifying patients for either de-labeling those with obviously non-immune-mediated reactions or identifying candidates for direct oral challenge test.
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