The rate of allergy labels to unconfirmed penicillin in children raises concerns


March 25, 2022

2 minute read



Taylor MG, et al. JAMA Network Open. 2022;doi:10.1001/jamanetworkopen.2022.2117.

Disclosures: The authors report no relevant financial information.

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According to a study published in Open JAMA Network.

The results showed that many penicillin allergy (PAL) tags in children were placed before the age of 2 years and after little or no penicillin exposure.

Data are from Taylor MG et al. JAMA Network Open. 2022; doi:10.1001/jamanetworkopen.2022.2117.

Margaret G. Taylor, MD, a clinical postdoctoral fellow at Baylor College of Medicine and colleagues noted that unconfirmed ALPs could lead to unnecessary use of broad-spectrum second-line antibiotics.

Children with unconfirmed ALP also have longer hospital stays, higher rates of adverse events, and more infections caused by Clostridium difficile and resistant to vancomycin Enterococcus than children who do not have PAL, the researchers wrote.

The retrospective longitudinal cohort study of birth was on 334 465 children (mean age at the time of censorship, 3.8 years; interquartile range [IQR], 1.7-6.6; 49.1% girls; 44.4% non-Hispanic white) attending 90 pediatric primary care practices linked to Texas Children’s Pediatrics (TCP) and Children’s Hospital of Philadelphia (CHOP).

During the study period, 946,592 penicillin derivatives were prescribed, most (80.2%) were prescribed as part of primary care.

Overall, 5.4% of these children had a PAL placed at a median age of 1.3 years (IQR, 0.9-2.3), with 90.8% placed in the 24 hours following primary care consultation or communication of health care. Only 12.5% of PAL were finally withdrawn during the study period.

Children identified as non-Hispanic white had a significantly higher probability of receiving a PAL than non-Hispanic black children (adjusted OR = 1.7; 95% CI, 1.6-1.8).

Children who received at least one penicillin prescription via primary care before age 2 were more likely to receive PAL than those who did not (aOR = 1.7; 95% CI, 1.6-1.8).

While 37.7% of children received a PAL after their first prescription of penicillin in TCP or CHOP care facilities, 7.9% were labeled without receiving penicillin prescription. Overall, according to researchers, nearly half of the children in the study received a PAL after one or zero prescription of penicillin.

Based on previous studies showing that less than 5% of children with PAL have a type 1 hypersensitivity allergy after skin tests or oral challenges, the researchers wrote that more than 16,000 children from their cohort would likely have inaccurate PALs.

The researchers called for quality improvement efforts directed at primary care providers, who are most likely to engage with children outside of acute illness, to treat unconfirmed PALs and identify ways to re-document these children.

Since most hypersensitivity responses follow at least two separate exposures to penicillin derivatives, the researchers wrote, the 37.7% of children who were labeled after their first penicillin prescription likely had a anticipated adverse reaction or an unspecified viral illness. Graded oral challenges may be required to withdraw their PALs.

ALPs given to children who did not receive penicillin may be due to in utero exposure to penicillin derivatives, exposure to cephalosporin antibiotics, or a family history of penicillin allergy, the authors wrote. researchers, adding that future research should explore the reasons for these PALs.

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