Parental Perceptions of Penicillin Allergy Risk Stratification and Delabeling

Abstract

Background: Penicillin (PCN) allergy labels are widely recognized to be highly inaccurate. Little is known about parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting.

Methods: Focus groups were held with parents of children and adolescents with a PCN allergy label discharged from a large academic children's hospital between January 1, 2019, and April 15, 2020. The open-ended, semistructured moderator guide included questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). Study investigators coded the transcripts and identified underlying themes using inductive and deductive thematic analysis.

Results: A total of 21 parents and 2 adolescents participated across 4 focus groups. We developed a theoretical framework depicting key elements of parents' and adolescents' experiences with PCN allergies, consisting of 4 major interconnected themes: (1) family context; (2) the invitation to delabel; (3) decision context; and (4) the PCN delabeling outcome. PCN allergies remained a concern for families even if their children passed an oral challenge. Some parents preferred testing to be performed in the hospital and felt this was a safer location for the procedure.

Conclusions: Parents are amenable to hospital based PCN allergy evaluation and delabeling. Further studies should incorporate parental and patient preferences to implement safe and effective PCN allergy delabeling processes in the hospital setting.

FIGURE 1

Theoretical framework for understanding the penicillin allergy delabeling experience. In this framework, the families’ understanding of the allergy reaction and testing process (family context) is engaged by the provider’s invitation to undergo the delabeling process (invitation to delabel). There is then a shared exchange of information of patient education by the provider and shared decision making and exchanged of information (overcoming resistance) between the provider and family. The bidirectional arrow represents the 2-way flow of information that may occur during the decision context process and obtaining more information through shared decision making or protocol adaptation changes. In response to the invitation to delabel, the family will then consider the decision to undergo the delabeling process (decision context) and come to a decision on whether to engage in the delabeling process.