All children who were considered minimal risk for penicillin allergy in a questionnaire demonstrated no allergy to the antibiotic in a study published in Pediatrics.
“A recent study in the pediatric ED revealed that the majority of the symptoms of penicillin allergy reported by families are low risk for true allergy,” David Vyles, DO, from the department of pediatric emergency medicine at the Medical College of Wisconsin, Milwaukee, and colleagues wrote. “… Because there is no process to safely and rapidly diagnose true penicillin allergy in an acute care setting, providers in the pediatric ED are reluctant to prescribe penicillin antibiotics to children with a reported penicillin allergy.”
To test the hypothesis that all children who come into the pediatric ED with low-risk penicillin allergy symptoms do not have a true penicillin allergy, the researchers administered an allergy questionnaire to 597 parents. One hundred prespecified children who had reported symptoms were further tested for penicillin allergy. They then calculated the number of negative allergy tests with a 95% confidence interval.
Of the 597 parents who completed the questionnaire, 51% (n = 302) of the children aged 4 to 18 years were eligible to be tested for the allergy based on their low-risk status. The median age of those tested was 9 years, and they were diagnosed at 1 year. The most frequently attributed symptoms included rash (97%) and itching (63%).
Every child tested (n = 100) demonstrated negative immunoglobulin E-mediated hypersensitivity to penicillin (95% CI [96.4%-100%]). Because of this testing, all could have the allergy removed from their medical record.
“The ability of the questionnaire to successfully identify a population likely to be at low risk for penicillin allergy was validated by subsequent gold standard allergy testing,” Vyles and colleagues wrote. “It identified a group of low-risk children who successfully passed an oral drug challenge. This highlights the questionnaire’s potential as a safe alternative to time-consuming, costly, and labor-prohibitive penicillin skin testing in the ED setting for select patients.” — by Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.