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. 2024 Apr;29(2):169-174.
doi: 10.5863/1551-6776-29.2.169. Epub 2024 Apr 8.

Beta-Lactam Allergy De-labeling in a Pediatric Hospital

Shawn Meehl  1 , Christina Salathe  1 , Chelsea Cooley  1 , Alejandro Jordan-Villegas  2 , Federico R Laham  2 , Akshita Madala  3 , Mallory Cowart  1
Affiliations

Beta-Lactam Allergy De-labeling in a Pediatric Hospital

Shawn Meehl et al. J Pediatr Pharmacol Ther. 2024 Apr.

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.

Keywords: de-labeling; oral amoxicillin challenge; pediatrics; penicillin allergy; penicillin skin testing.

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Conflict of interest statement

Disclosure. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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