David Vyles1, James W Antoon2, Allison Norton3, Cosby A Stone3, Jason Trubiano4, Alexandra Radowicz5, Elizabeth J Phillips6. 1. Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: dvyles@mcw.edu. 2. Department of Pediatric and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. 3. Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia; Department of Infectious Diseases and Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia. 5. Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 6. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Abstract
OBJECTIVE: To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children. DATA SOURCES: Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review. STUDY SELECTIONS: Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label. RESULTS: This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy. CONCLUSION: Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.
OBJECTIVE: To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children. DATA SOURCES: Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review. STUDY SELECTIONS: Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label. RESULTS: This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy. CONCLUSION:Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.
Authors: Derek R MacFadden; Anthony LaDelfa; Jessica Leen; Wayne L Gold; Nick Daneman; Elizabeth Weber; Ibrahim Al-Busaidi; Dan Petrescu; Ilana Saltzman; Megan Devlin; Nisha Andany; Jerome A Leis Journal: Clin Infect Dis Date: 2016-07-11 Impact factor: 9.079
Authors: David Vyles; Asriani Chiu; John Routes; Mariana Castells; Elizabeth J Phillips; Jennifer Kibicho; David C Brousseau Journal: Pediatrics Date: 2018-05 Impact factor: 7.124
Authors: C Ponvert; Y Perrin; A Bados-Albiero; M Le Bourgeois; C Karila; C Delacourt; P Scheinmann; J De Blic Journal: Pediatr Allergy Immunol Date: 2011-03-30 Impact factor: 6.377
Authors: James W Antoon; Carlos G Grijalva; Alison G Grisso; Cosby A Stone; Jakobi Johnson; Justine Stassun; Allison E Norton; Sunil Kripalani; Derek J Williams Journal: Hosp Pediatr Date: 2022-07-01
Authors: Katherine Collins; Kristina Rueter; Michaela Lucas; David Sommerfield; Aine Sommerfield; Nazim Khan; Britta S von Ungern-Sternberg Journal: J Paediatr Child Health Date: 2022-05-03 Impact factor: 1.929