In the Journals

Most penicillin allergy challenges tolerated; costs reduced when label removed

David Vyles, MD
David Vyles

All children in one cohort who were labeled as penicillin allergic but tested negative for the allergy were able to tolerate a challenge, according to findings published in Pediatrics.

Additionally, when patients’ allergy labels were removed, significant costs savings were reported, with $192,223 potentially saved by children visiting EDs.

“The majority of children with reported penicillin allergy could likely tolerate penicillin without having an allergic or adverse reaction,” David Vyles, DO, MS, from the section of pediatric emergency medicine at the Medical College of Wisconsin, Milwaukee, and colleagues wrote. “The labeling of a patient with a penicillin allergy has many negative effects that include increased health risks and prescription costs.”

To examine whether serious adverse events were related to exposing those previously labeled as pencillin allergic to penicillin and whether prescribing practices would shift after this testing, the researchers conducted a follow-up case series that included 100 children. These children were tested for penicillin allergy, and all results were negative. A follow-up was conducted and included surveys for both parents and primary care providers.

Once data from the surveys were collected, Vyles and colleagues combined the information to create abridged versions of the features associated with pediatric patients and survey responses from parents and PCPs. Prescription data were used to conduct a three-tier economic analysis that revealed cost savings, cost avoidance and potential cost savings.

Of the 100 children included in the study, 46 prescriptions were reported for 36 patients within 1 year of a penicillin allergy test, according to PCPs or parents, or both. Penicillin derivatives were prescribed and filled for 58% of these children. Only one child reported a rash after beginning treatment with the antibiotic, and no adverse events were observed after attempting a penicillin challenge.

When patients were no longer labeled as penicillin allergic, $1,368.13 were saved, and the researchers observed a cost avoidance of $1,812. For patients treated in pediatric EDs, $192,223 could be potentially saved by removing patients’ labeling for penicillin allergy.

“It is interesting to note that all patients who were tested for penicillin allergy had low-risk symptoms of allergy, such as rash, that often developed days after initial exposure to the antibiotic,” Vyles and colleagues wrote. “Therefore, it is likely that they were never allergic in the first place. However, it reveals the powerful effect a labeled allergy can have on a family and the difficulty in reassuring families even with low-risk symptoms and negative results for allergy testing.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

David Vyles, MD
David Vyles

All children in one cohort who were labeled as penicillin allergic but tested negative for the allergy were able to tolerate a challenge, according to findings published in Pediatrics.

Additionally, when patients’ allergy labels were removed, significant costs savings were reported, with $192,223 potentially saved by children visiting EDs.

“The majority of children with reported penicillin allergy could likely tolerate penicillin without having an allergic or adverse reaction,” David Vyles, DO, MS, from the section of pediatric emergency medicine at the Medical College of Wisconsin, Milwaukee, and colleagues wrote. “The labeling of a patient with a penicillin allergy has many negative effects that include increased health risks and prescription costs.”

To examine whether serious adverse events were related to exposing those previously labeled as pencillin allergic to penicillin and whether prescribing practices would shift after this testing, the researchers conducted a follow-up case series that included 100 children. These children were tested for penicillin allergy, and all results were negative. A follow-up was conducted and included surveys for both parents and primary care providers.

Once data from the surveys were collected, Vyles and colleagues combined the information to create abridged versions of the features associated with pediatric patients and survey responses from parents and PCPs. Prescription data were used to conduct a three-tier economic analysis that revealed cost savings, cost avoidance and potential cost savings.

Of the 100 children included in the study, 46 prescriptions were reported for 36 patients within 1 year of a penicillin allergy test, according to PCPs or parents, or both. Penicillin derivatives were prescribed and filled for 58% of these children. Only one child reported a rash after beginning treatment with the antibiotic, and no adverse events were observed after attempting a penicillin challenge.

When patients were no longer labeled as penicillin allergic, $1,368.13 were saved, and the researchers observed a cost avoidance of $1,812. For patients treated in pediatric EDs, $192,223 could be potentially saved by removing patients’ labeling for penicillin allergy.

“It is interesting to note that all patients who were tested for penicillin allergy had low-risk symptoms of allergy, such as rash, that often developed days after initial exposure to the antibiotic,” Vyles and colleagues wrote. “Therefore, it is likely that they were never allergic in the first place. However, it reveals the powerful effect a labeled allergy can have on a family and the difficulty in reassuring families even with low-risk symptoms and negative results for allergy testing.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.