BETA-LACTAM ALLERGY DE-LABELING IN A PEDIATRIC POPULATION
Main Article Content
Keywords
de-labeling, oral amoxicillin challenge, pediatrics, penicillin allergy, penicillin skin testing
Abstract
OBJECTIVE
To assess the ability to de-label pediatric patients of their beta-lactam allergy by using a newly implemented institutional protocol and to identify potential barriers to the de-labeling process.
METHODS
All patients with reported allergies to prespecified beta-lactam antibiotics were eligible for a beta-lactam allergy interview. Following the interview, patients were grouped into 4 risk categories—no risk, low risk, moderate risk, and high risk—and assessed for intervention eligibility. Potential interventions included de-labeling based on the interview alone or proceeding to an oral amoxicillin challenge with or without penicillin allergy skin testing.
RESULTS
Of the 62 patients eligible for beta-lactam allergy interviews, 40% (n = 25) were de-labeled. Among de-labeled patients, 60% (n = 15) were de-labeled on the basis of the interview alone. Additionally, no failures were documented in patients who underwent an oral amoxicillin challenge or penicillin skin testing. Barriers to performing oral amoxicillin challenges or penicillin skin testing included concomitant systemic steroid or antihistamine use, refusal of intervention, and insufficient resources to perform penicillin skin testing.
CONCLUSIONS
There was a high frequency of patients de-labeled of their beta-lactam allergies in this study. Increased education to patients, parents, and providers on the de-labeling process, as well as increased personnel available to coordinate and perform de-labeling interventions, may result in more beta-lactam allergy de-labeling
References
2. Bauer ME, MacBrayne C, Stein A, et al. A multidisciplinary quality improvement initiative to facilitate penicillin al- lergy delabeling among hospitalized pediatric patients. Hosp Peds. 2021;11(5):427–434.
3. Vyles D, Chiu A, Routes J, et al. Oral amoxicillin challenges in low-risk children during a pediatric emergency department visit. J Allergy Clin Immunol Pract. 2020;8(3):1126–1128.
4. Kuruvilla M, Shih J, Patel K, et al. Direct oral amoxicillin challenge without preliminary skin testing in adult pa- tients with allergy and at low risk with reported penicillin allergy. Allergy Asthma Proc. 2019;40(1):57–61.
5. Tucker MH, Lomas CM, Ramchandar N, et al. Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of Marine recruits. J Allergy Clin Immunol Pract. 2017;5(3):813–815.
6. Macy E, Contreras R. Health care use and serious in- fection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol Pract. 2014;133(3):790–796.
7. Macy E, Vyles D. Who needs penicillin allergy testing? Ann Allergy Asthma Immunol. 2018;121(5):523–529.
8. Gateman DP, Rumble JE, Protudjer JLP, et al. Amoxicil- lin oral provocation challenge in a primary care clinic: a descriptive analysis. CMAJ Open. 2021;9(2):E394–E399.
9. Mill C, Primeau M, Medoff E, et al. Assessing the diagnostic properties of a graded oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. JAMA Pediatr. 2016;170(6):e160033.
10. Stone CA, Trubiano J, Coleman DT, et al. The challenge of de-labeling penicillin allergy. Allergy. 2019;75(2):273–288.
11. Macy E, McCormick TA, Adams JL, et al. Association be- tween removal of a warning against cephalosporin use in
12. patients with penicillin allergy and antibiotic prescribing. JAMA Netw Open. 2021;4(4):e218367.
13. Jeimy S, Ben-Shoshan M, Abrams EM, et al. Practical Guide for Evaluation and Management of Beta-Lactam Allergy: Position Statement from the Canadian Society of Allergy and Clinical Immunology. Allergy Asthma Clin Immunol. 2020;16(1):95.
14. Steenvoorden L, Bjoernestad EO, Kvesetmoen TA, et al. De-labelling penicillin allergy in acutely hospitalized patients: a pilot study. BMC Infect Dis. 2021;21(1):1083.
15. Jones TW, Fino N, Olson J, et al. The impact of beta- lactam allergy labels on hospitalized children. Infect Control Hosp Epidemiol. 2020;42(3):318–324.
16. Antoon JW, Grijalva CG, Grisso AG, et al. Feasibility of a centralized, pharmacy-led penicillin allergy delabeling program. Hosp Pediatr. 2022;12(7):e230–237.
17. Iammatteo M, Alvarez Arango S, Ferastraoaru D, et al. Safety and outcomes of oral graded challenges to amoxi- cillin without prior skin testing. J Allergy Clin Immunol Pract. 2019;7(1):236–243.
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Dr Mohit Aggarwal
Assistant professor , department of paediatrics , VIMS , gajraula
Dr Niraj Kumar
Assistant professor, department of paediatrics , VIMS , gajraula