Reducing Unnecessary Penicillin Allergy Labels in the Pediatric Surgical Population

Area of Science:

• Pediatric Allergy and Immunology
• Quality Improvement in Healthcare
• Surgical Patient Management

Background:

• Up to 10% of children are labeled with penicillin allergy, often inaccurately, leading to adverse outcomes and increased costs.
• Unnecessary penicillin allergy labels can result in suboptimal antibiotic selection and treatment failures.
• At a pediatric surgical center, 7% of patients carried a penicillin allergy label prior to the intervention.

Purpose of the Study:

• To decrease the rate of penicillin allergy labeling in pediatric surgical patients.
• To improve timely access to penicillin allergy evaluations.
• To assess the safety and efficacy of oral provocation testing (OPT) in this population.

Main Methods:

• A pre/postimplementation study design was employed.
• Pediatric surgical patients with a penicillin allergy label were identified and risk-stratified.
• A single-dose oral provocation test (OPT) with amoxicillin was administered to eligible patients.

Main Results:

• The percentage of patients with a penicillin allergy label decreased from 7% to 6.4% post-intervention (P=.045).
• Median wait time for allergy evaluation significantly reduced from 102 days to 42 days (P<.0001).
• Forty-two patients successfully completed the oral provocation test without adverse events.

Conclusions:

• This quality improvement initiative effectively reduced penicillin allergy labeling rates in pediatric surgical patients.
• The project enhanced access to allergy evaluations, shortening wait times considerably.
• Oral provocation testing proved to be a safe and effective method for de-labeling penicillin allergy in this cohort.