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Delabelling suspected amoxicillin allergy in pediatric patients using oral challenge: a retrospective study from
Taha Sadeghi1, Parisa Mirzajani2, Rua Suror3
1Clinical Research Services Division (CRSD), Thunder Bay Regional Health Research Institute (TBRHRI), Thunder Bay, ON, Canada.
Insights
Most children labeled with amoxicillin allergy are not truly allergic. A direct oral amoxicillin challenge safely removes incorrect allergy labels in low-risk pediatric patients, improving antibiotic use.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Incorrect penicillin allergy labels are common in children.
- These labels can lead to the use of broader-spectrum antibiotics, contributing to antibiotic resistance.
- Accurate allergy assessment is crucial for appropriate antibiotic selection.
Purpose of the Study:
- To determine the true prevalence of amoxicillin allergy in children with a reported allergy label.
- To evaluate the safety and efficacy of direct oral amoxicillin challenge for allergy delabeling in low-risk pediatric patients.
- To assess the impact of delabeling on antibiotic stewardship.
Main Methods:
- Retrospective review of pediatric patients (6 months-15 years) with suspected amoxicillin allergy.
- Patients underwent a direct oral amoxicillin challenge without prior skin testing.
- Clinical data and reaction types were descriptively summarized.
Main Results:
- Out of 96 patients, 93 (96.9%) tolerated the oral amoxicillin challenge.
- Three patients (3.1%) developed mild, delayed rashes, consistent with prior reported reactions.
- No severe immediate reactions were observed during the oral challenge.
Conclusions:
- The prevalence of true amoxicillin allergy in this low-risk pediatric cohort was 3.1%.
- Direct oral amoxicillin challenge is a safe and effective method for delabeling children with suspected amoxicillin allergy.
- Implementing this strategy can improve antibiotic stewardship, reduce costs, and enhance patient care.
Abstract:
To determine the proportion of children labelled as allergic to amoxicillin who are truly allergic and to assess whether a direct oral amoxicillin challenge, without prior skin testing, is a safe and effective way to remove incorrect allergy labels in low-risk pediatric patients in Northwestern Ontario. We conducted a retrospective review of pediatric patients (6 months-15 years) referred for suspected amoxicillin allergy at two Northwestern Ontario hospitals between 2015 and 2025. Eligible patients underwent oral amoxicillin challenge. Clinical data were summarized descriptively. Of 96 patients, 93 (96.9%) tolerated the oral amoxicillin challenge, while 3 (3.1%) developed mild, delayed rashes. All three had previously reported delayed reactions (5-10 days) after their initial amoxicillin exposure. Two patients developed delayed rashes that were consistent with their previously documented maculopapular reactions, based on EMR documentation and caregiver-reported descriptions.Conclusion: The prevalence of true amoxicillin allergy among low-risk pediatric patients carrying a reported "penicillin allergy" label in our cohort of 96 patients evaluated at our pediatric allergy clinics in Northwestern Ontario was 3.1%. Oral amoxicillin challenge without prior skin testing proved to be a safe and effective approach for delabelling low-risk children. Broader implementation of this strategy could enhance antibiotic stewardship, reduce healthcare-related costs, and improve patient care.
