Stratifying Penicillin Allergy Risk in a Pediatric Population

Beta-lactams are among the safest, most used, and effective antibiotics, especially for common pediatric infections. However, they are also among the most frequently reported drug allergies, prompting broad-spectrum and off-label antibiotic use. Prior studies have shown most children with documented penicillin reactions tolerate oral drug challenge and may have their penicillin allergy removed. A survey detailing the drug reaction was distributed to electronic medical record identified penicillin allergic patients seen at Duke Pediatrics South Durham from September 2019 until June 2020. This survey was adapted from the 2019 JAMA article by Shenoy et al. The patients were risk stratified into three categories: 1) low-risk—allergy removed without evaluation, 2) moderate-risk—penicillin skin testing and challenging warranted, and 3) high-risk— allergy retained without additional evaluation. Percentage of patients in each risk category was analyzed. A total of 78 patients were included. Rashes were the most common reaction reported by 92% of patients. Most reactions were delayed, with 26% being 1-5 days after starting medication and 23% more than 5 days after beginning therapy. Notably, no reactions required epinephrine. Of families surveyed, 78% were very interested in allergy testing and only 8% were opposed. In the cohort, 3% had a high-risk reaction, 1% low-risk and 96% of patients were deemed moderate-risk and qualified for further evaluation. Most patients have moderate-risk reactions and are interested in evaluation. Future studies aim to increase access to evaluations, eliminate inaccurate allergies, and determine the ability to proceed to oral challenge without skin testing.