Your Child May Not Truly Be Allergic To Penicillin

Reported penicillin allergies in children usually inconsistent with true allergy

Jul 3, 2017

Clinical Essentials from Pediatrics

Takeaway
• Parent-reported penicillin allergy symptoms in children presenting to the emergency department (ED) are likely inconsistent with true, immunoglobulin E-mediated allergy when evaluated by the 3-tier penicillin allergy questionnaire.

• Data demonstrate that the true incidence of penicillin allergy is 0.004%-0.015%.

Why this matters
• Because of time constraints and invasiveness associated with standard allergy testing, an allergy pediatric questionnaire may optimize first-line penicillin use in children presenting with the ED with parent-reported penicillin allergies.

• Data suggest that the majority of reported pediatric penicillin allergy symptoms (eg, maculopapular rash, hives, vomiting, diarrhea) are actually low risk for true allergy.

Study design
• This study evaluated 597 children between the ages of 3.5 and 18 y for penicillin allergy, reported by the parent through an allergy questionnaire.

• Patients underwent penicillin allergy testing by percutaneous skin tests.

Funding: American Academy of Pediatrics.

Key results
• Result from the questionnaire showed that 434 children had low-risk symptoms of allergy to penicillin; 163 had at least 1 high-risk symptom of allergy.

• Rash (97%) and itching (63%) were the most common parent-reported allergy symptoms.

• All 100 children selected for allergy testing were found to have negative results for penicillin allergy and had the allergy removed from their medical record.

Limitations
• Risk for bias.

Coauthored with Chitra Ravi, MPharm
CURATED BY Liz Scherer