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. 2018 May;141(5):e20173466.
doi: 10.1542/peds.2017-3466.

Antibiotic Use After Removal of Penicillin Allergy Label

David Vyles  1 , Asriani Chiu  2 , John Routes  2 , Mariana Castells  3 , Elizabeth J Phillips  4 , Jennifer Kibicho  5 , David C Brousseau  6
Affiliations

Antibiotic Use After Removal of Penicillin Allergy Label

David Vyles et al. Pediatrics. 2018 May.

Abstract

Background: Penicillin allergy is commonly reported in the pediatric emergency department. We previously performed 3-tier penicillin allergy testing on children with low-risk symptoms, and 100% tolerated a penicillin challenge without an allergic reaction. We hypothesized that no serious allergic reactions would occur after re-exposure to penicillin and that prescription practices would change after testing.

Methods: We performed a follow-up case series of 100 children whose test results were negative for penicillin allergy. Research staff administered a brief follow-up phone survey to the parent and primary care provider of each patient tested. We combined the survey data and summarized baseline patient characteristics and questionnaire responses. We then completed a 3-tier economic analysis from the prescription information gathered from surveys in which cost savings, cost avoidance, and potential cost savings were calculated.

Results: A total of 46 prescriptions in 36 patients were reported by the primary care provider and/or parents within the year after patients were tested for penicillin allergy. Twenty-six (58%) of the prescriptions filled were penicillin derivatives. One (4%) child developed a rash 24 hours after starting the medication; no child developed a serious adverse reaction after being given a penicillin challenge. We found that the cost savings of delabeling patients as penicillin allergic was $1368.13, the cost avoidance was $1812.00, and the total potential cost savings for the pediatric emergency department population was $192 223.00.

Conclusions: Children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction developing. Delabeling children changed prescription behavior and led to actual health care savings.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Prescriptions since antibiotic testing. PMD, primary medical doctor.
FIGURE 2
FIGURE 2
Extrapolated total cost savings of delabeling patients with penicillin allergy.
See this image and copyright information in PMC

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