Safety of Direct Amoxicillin Challenges to Evaluate Penicillin Allergy in Infants and Toddlers

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Pharmacology
• Infectious Diseases

Background:

• Penicillin allergy labels are common in children but often inaccurate.
• Unnecessary avoidance of penicillin-class antibiotics can lead to broader-spectrum antibiotic use.
• Limited data exist on the safety of direct amoxicillin challenges in infants and toddlers with non-high-risk penicillin allergy labels.

Purpose of the Study:

• To evaluate the safety and outcomes of direct amoxicillin challenges in infants and toddlers with a non-high-risk penicillin allergy label.
• To assess the feasibility of penicillin allergy delabeling in this pediatric population.

Main Methods:

• Retrospective cohort study conducted at two pediatric referral centers.
• Inclusion of infants and toddlers with a non-high-risk penicillin allergy label.
• Review of medical records for reactions following direct amoxicillin challenges.

Main Results:

• Direct amoxicillin challenges were well-tolerated in the studied pediatric population.
• No significant adverse reactions were observed during or after the amoxicillin challenges.
• The study supports the safety of this approach for allergy delabeling.

Conclusions:

• Direct amoxicillin challenges are a safe strategy for infants and toddlers with non-high-risk penicillin allergy labels.
• Early penicillin allergy delabeling can be safely extended to this younger population.
• This approach may help optimize antibiotic selection and reduce the use of alternative agents.