Deficiencies in the Assessment of Penicillin Allergy in Hospitalized Children in Hawai'i, 2021-2023

Area of Science:

• Pediatric Allergy and Immunology
• Infectious Diseases
• Clinical Pharmacology

Background:

• Claims of penicillin allergy are frequent but often unconfirmed upon evaluation.
• National guidelines recommend thorough allergy assessment and "delabeling" when appropriate.
• Unverified penicillin allergy can lead to unnecessary interventions and suboptimal antibiotic selection.

Purpose of the Study:

• To assess the frequency of penicillin allergy claims in hospitalized children.
• To evaluate the appropriateness of allergy assessment and subsequent interventions.
• To identify factors contributing to the overuse of second-line antibiotics.

Main Methods:

• Retrospective review of medical records for hospitalized children.
• Inclusion criteria: Children hospitalized between January 1, 2021, and June 30, 2023.
• Data collected: Penicillin allergy claims, documentation of allergy nature, interventions, and antibiotic use.

Main Results:

• Out of 3484 hospitalized children, 97 (2.8%) reported a penicillin allergy.
• Documentation of allergy details was incomplete for 97% of cases.
• 46.8% of patients requiring antibiotics received second-line agents due to allergy claims.

Conclusions:

• Inadequate penicillin allergy evaluation is prevalent in pediatric hospital settings.
• Improved documentation and risk stratification are needed to guide appropriate antibiotic selection.
• Enhanced provider education is essential to address penicillin allergy overdiagnosis and improve antibiotic stewardship.