Prevalence of penicillin allergy label similar among kids, adults

The number of inpatients with a penicillin allergy label at a children’s hospital approached 9%, according to results from a retrospective chart review presented at SHM Converge — the virtual meeting of the Society of Hospital Medicine.

“This is pretty on trend with what's out there in the adult world,” Katherine Dyer, DO, a pediatric hospital medicine fellow at Phoenix Children’s Hospital, said during a pre-recorded poster session.

According to the American Academy of Allergy, Asthma and Immunology, about 10% of patients report an allergy to penicillin, but more than 90% may not be truly allergic. This opens the door to increased prescriptions of broad-spectrum antibiotics as an alternative.

Dyer and colleagues noted that most studies of penicillin allergy labels have been conducted in adults, but there is a “paucity of literature” on the impact of a penicillin allergy label in children. They reviewed charts from 13,273 children aged 0 to 18 years who were admitted to their hospital. The study excluded children who were immunocompromised, had an organ transplant, were admitted to an ICU or received oncology services.

The researchers reported that 8.6% of the children had a penicillin allergy label. Of these, 6,960 received antibiotics during their hospitalization and were included in the data analysis. About half of inpatients with a penicillin allergy label (51.5%) received antibiotics during their stay, and a comparable number of children without an allergy label (52.5%) received antibiotics. Inpatients with an allergy label tended to be older (mean age 8.3 vs. 6.2 years, P < .0001) and Hispanic or Latino (45% vs. 37%, P < .0001).

Antibiotic prescribing rates were significantly higher among children who had a penicillin allergy label compared with patients who did not have an allergy label for fourth-generation cephalosporins (22% vs. 13%, P < .0001), lincosamides (20% vs. 8%, P < .0001) and sulfonamides (25% vs. 15%, P <.0001). Conversely, prescribing rates were significantly lower among patients with a penicillin allergy label for first-generation cephalosporins (20% vs. 24%, P = .02) and aminoglycosides (5% vs. 8%, P = .01).

“Given the potential risks of prescribing these types of antibiotics, which may be a more broad spectrum than necessary, the importance of confirming allergy status and judicious antibiotic prescribing is highlighted,” Dyer said.

She said future studies should examine among children by their diagnosis or culture results “to further assess antibiotic prescribing practices and the appropriateness of the antibiotic selections.”

References:

• American Academy of Allergy, Asthma and Immunology. Penicillin allergy FAQ. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/penicillin-allergy-faq. Accessed May 6, 2021.
• Dyer K, et al. Impact of reported penicillin allergies on antibiotic prescribing practices in inpatient pediatrics. Presented at: Society of Hospital Medicine Converge Meeting; May 4-May 7, 2021 (virtual meeting).