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Majority of children with penicillin allergy display low-risk symptoms

BALTIMORE — More than 75% of children diagnosed with penicillin allergy displayed low-risk symptoms that were not likely to be conducive with true allergy, according to recent study findings presented at the Pediatric Academic Societies Meeting.

“Children often present to the pediatric ED with a reported penicillin allergy,” study researcher David Vyles, DO, of the Medical College of Wisconsin, told Infectious Diseases in Children. “The true incidence of pediatric penicillin allergy is low, and patients may be inappropriately denied first-line antibiotics due to misunderstood or misdiagnosed penicillin allergy. We hypothesized that 70% of penicillin allergy as reported by families were low risk for true penicillin allergy.”

David Vyles

Parents of children aged 0 to 18 years who visited the pediatric ED for reported penicillin allergy were asked to complete a survey about their child. Five hundred of 605 parents who were approached completed the survey. Preceding survey implementation, a pediatric allergist categorized symptoms into “high” and “low” risk.

“The allergy questionnaire included 17 items assessing allergy history and parent report of their child’s race,” Vyles. Questions included the patient’s age at diagnosis, symptoms, time to allergic reaction from first dose, indication for antibiotic prescription and whether a parent and/or physician diagnosed the allergy.

The median ages of high-risk and low-risk patients were 6.7 years and 6.2 years, respectively. Seventy-five percent of the patients were diagnosed with penicillin allergy at age 2 years or younger. Most children were treated with antibiotics for an ear infection.

“Overall, 380 parents reported exclusively low-risk allergy symptoms. The remaining 120 parents reported one or more high-risk allergy symptoms,” Vyles said.

Low-risk allergy symptoms most commonly included non-hive, hive and nonspecified rashes (93%) and itching (41%). A picture chart of rashes was provided on the survey to help parents better delineate rash types. Facial swelling (10%) and difficulty breathing (4%) were among the most common high-risk allergy symptoms.

A majority of parents reported that their PCP diagnosed the allergy — oftentimes without seeing the rash.

“Our results suggest that reported penicillin allergy in the pediatric ED frequently correlates to low-risk symptoms that likely do not reflect true allergy,” Vyles said. “Our next steps are to determine if patients who report low-risk symptoms of allergy to penicillin have true allergy by the standard testing process.” – by Alaina Tedesco 

Reference:

Vyles D, et al. Abstract 3835.334. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: The researchers report no relevant financial disclosures. Funding for the study was provided by the AAP Ken Graff Award.