David Vyles1, Rakesh D Mistry2, Viday Heffner3, Patrick Drayna3, Asriani Chiu4, Alexis Visotcky5, Raphael Fraser5, David C Brousseau3. 1. Pediatric Emergency Medicine (D Vyles, V Heffner, P Drayna, and DC Brousseau),. Electronic address: dvyles@mcw.edu. 2. Pediatric Emergency Medicine, Children's Hospital of Colorado, (R Mistry) Denver. 3. Pediatric Emergency Medicine (D Vyles, V Heffner, P Drayna, and DC Brousseau). 4. Allergy and Immunology (A Chiu), and. 5. Division of Biostatistics (A Visotcky and R Fraser), Medical College of Wisconsin, Milwaukee.
Abstract
BACKGROUND: Pediatric emergency medicine (PEM) and primary care provider (PCP) providers are the most likely physicians to initially label a child as allergic to penicillin. Differences in knowledge and management of reported penicillin allergy between these 2 groups have not been well characterized. METHODS: A cross-sectional, 20-question survey was administered to PEM and PCPs to ascertain differential knowledge and management of penicillin allergy. Knowledge regarding high- and low-risk symptoms for true allergy and extent of history taking regarding allergy were compared between the 2 groups using t tests, Chi-square, and Wilcoxon tests. RESULTS: In total, 182 PEM and 54 PCPs completed the survey. PEM and PCPs reported that 74.1 ± 19.5% and 69.0 ± 23.8% of patients with remote low-risk symptoms of allergy could tolerate penicillin without an allergic reaction. PEM and PCPs incorrectly identified low-risk symptoms of allergy as high-risk, including vomiting with medication administration and delayed skin rash. PCPs took more detailed allergy histories when compared with PEM providers. In total, 143 (78.5%) of PEM providers and 51 (94.4%) PCPs were interested in using a penicillin allergy questionnaire to segregate children into high- or low-risk categories. CONCLUSIONS: Most pediatric providers believe that children with a remote history of low-risk allergy symptoms could tolerate penicillin without an allergic reaction; however, this is infrequently acted upon. Both PEM and PCP providers were likely to classify low-risk symptoms as high-risk and infrequently referred children for further detailed allergy assessment. Both groups were receptive to decision support measures to facilitate improved penicillin allergy classification and labeling and support antibiotic appropriateness in their patients.
BACKGROUND: Pediatric emergency medicine (PEM) and primary care provider (PCP) providers are the most likely physicians to initially label a child as allergic to penicillin. Differences in knowledge and management of reported penicillinallergy between these 2 groups have not been well characterized. METHODS: A cross-sectional, 20-question survey was administered to PEM and PCPs to ascertain differential knowledge and management of penicillinallergy. Knowledge regarding high- and low-risk symptoms for true allergy and extent of history taking regarding allergy were compared between the 2 groups using t tests, Chi-square, and Wilcoxon tests. RESULTS: In total, 182 PEM and 54 PCPs completed the survey. PEM and PCPs reported that 74.1 ± 19.5% and 69.0 ± 23.8% of patients with remote low-risk symptoms of allergy could tolerate penicillin without an allergic reaction. PEM and PCPs incorrectly identified low-risk symptoms of allergy as high-risk, including vomiting with medication administration and delayed skin rash. PCPs took more detailed allergy histories when compared with PEM providers. In total, 143 (78.5%) of PEM providers and 51 (94.4%) PCPs were interested in using a penicillinallergy questionnaire to segregate children into high- or low-risk categories. CONCLUSIONS: Most pediatric providers believe that children with a remote history of low-risk allergy symptoms could tolerate penicillin without an allergic reaction; however, this is infrequently acted upon. Both PEM and PCP providers were likely to classify low-risk symptoms as high-risk and infrequently referred children for further detailed allergy assessment. Both groups were receptive to decision support measures to facilitate improved penicillinallergy classification and labeling and support antibiotic appropriateness in their patients.
Authors: Mary L Staicu; David Vyles; Erica S Shenoy; Cosby A Stone; Taylor Banks; Kristin S Alvarez; Kimberly G Blumenthal Journal: J Allergy Clin Immunol Pract Date: 2020-10
Authors: David Vyles; James W Antoon; Allison Norton; Cosby A Stone; Jason Trubiano; Alexandra Radowicz; Elizabeth J Phillips Journal: Ann Allergy Asthma Immunol Date: 2020-03-26 Impact factor: 6.347