Pediatric amoxicillin allergy challenges can occur during routine primary care visits

LOUISVILLE, Ky. — Pediatric primary care offices can perform graded oral amoxicillin challenges during routine visits, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Penicillin allergy labels are common in childhood. However, over 95% of patients with penicillin allergy labels can safely tolerate penicillin,” Gaytri Patel, MD, a second-year allergy and immunology fellow at UT Southwestern Medical Center, said during her presentation.

“Previous studies have demonstrated the safety and efficacy of amoxicillin challenges in children with a penicillin allergy label,” she continued. “There is a need for novel strategies to increase penicillin allergy testing beyond specialist centers.”

Gaytri Patel

Patel and colleagues recruited 87 children aged 2 to 18 years (54% boys; 31% white) with a penicillin allergy label who presented for routine visits at an outpatient general pediatrics clinic. Telephone screenings gathered information about the patients’ reactions and parental beliefs connected to penicillin allergy.

Parents answered questions about their child’s history of penicillin reactions. More than 80% reported rash, which was the most common reaction, followed by facial swelling, diarrhea and fever, reported by approximately 30% each.

Seventeen participants received 250 mg of amoxicillin spread between two doses, followed by a 60-minute observation period where they completed their routine pediatric visit. Seven to 10 days later, researchers assessed delayed symptoms via phone.

“So far ... 17 patients have completed and passed the amoxicillin challenge,” Patel said.

When parents were surveyed, 27 agreed with the statement that it is important for their child to have penicillin allergy testing, with 11 strongly agreeing, 17 neither agreeing nor disagreeing and seven disagreeing.

Also, 34 parents disagreed with the statement that avoiding penicillin could negatively impact their child’s health, with 14 agreeing, four strongly agreeing and 10 neither agreeing nor disagreeing.

The researchers further asked 20 of the parents of children who did not take the challenge why they did not participate. The most common response (80%) was that they were worried a reaction would cause a worse allergy. Other common responses included:

• I think my child can avoid penicillin without any adverse effects (45%);
• I personally think my child is still allergic regardless of testing (45%);
• I do not have enough time to schedule this test (40%);
• My child is afraid of having a reaction (35%);
• My child will have difficulty taking medication (15%);
• My child is too young (10%); or
• Other (35%).

Only one of the patients who completed the challenge had a reaction, which was a delayed rash that resolved with antihistamines after 2 days. Also, 94% of the parents whose children completed the challenge said they will give penicillin to their child in the future if required.

“These preliminary results suggest that graded oral amoxicillin challenges can be performed in a pediatric primary care setting during routine visits,” Patel said.