Inaccurate pediatric penicillin allergy labels successfully delabeled

Key takeaways:

• Out of 121 patients, 14 were delabeled in a primary care office and 13 were delabeled with an allergist.
• Only 14 out of 25 allergist-referred patients attended a follow-up visit.

ORLANDO — Delabeling inappropriate penicillin allergy labels in outpatient pediatric patients is feasible, according to an abstract presented at the American Academy of Pediatrics National Conference & Exhibition.

Inaccurate penicillin allergy labeling may lead to higher antibiotics resistance rates and an increase in health care costs, Matthew Merola, MD, pediatrics resident physician at NYU Langone Hospital – Long Island, and colleagues wrote.

Noting that up to 90% of children with a penicillin allergy label do not have a true allergy, the researchers aimed to reduce inaccurate labeling by 10% in outpatient pediatric patients from September 2021 to June 2024.

This study created a team of generalists, specialists, residents and medical students to comprehensively evaluate pediatric patients with a penicillin allergy label. One of their interventions consisted of educating attending and resident physicians on penicillin allergy labels and subsequent referrals to allergists. They also met as a team pre-visit to specify which patients were presenting for well visits and had a penicillin allergy label.

A penicillin allergy questionnaire was used by providers to assess penicillin allergy history, and those determined to be “no-risk” or “low risk” were delabeled in the primary care office. Those labeled “medium” or “high risk” were referred to an allergist. Allergists then conducted an oral amoxicillin challenge or skin testing.

Among the 121 patients with a penicillin allergy label, 14 were delabeled in the primary care office, and 31 were referred to an allergist (median referral rate, 26%). Out of the referred patients, 25 were seen by an allergist. Of these 25 patients, 14 returned for a follow-up visit and 13 were delabeled.

Study authors noted that challenges included getting more providers to use the questionnaire and delabel in-office and following up with patients who received allergist referrals. Barriers to care might also exist that prevent patients returning for a follow-up visit with their allergist.