CLINICAL PRACTICE GUIDELINES (FULL LIST)

Penicillin Allergy Delabeling (CPG)

Penicillin allergy labels are common in pediatric patients, however, <1% of these patients are truly allergic. These labels are associated with significant morbidity including alternative and broader spectrum antibiotic use, longer hospital stays and readmittance, and higher medical costs. These patients should be risk stratified as defined in the CPG. If the patient’s history is high risk and there are reasonable alternatives for treatment, please refer them to Pediatric Allergy Clinic for consultation. If the patient is high risk and there are no reasonable alternatives, please consult Pediatric Allergy to determine if desensitization would be appropriate.

If the patient’s history is inconsistent with allergy, the patient may be de-labeled without a challenge. If the patient is low risk, then they can go straight to challenge with a dose of amoxicillin under observation. Children with a low-risk penicillin allergy history who undergo amoxicillin challenge have a 3-5% chance of an allergic reaction which is typically benign and easily treatable. Recent publications support that amoxicillin challenges can be both efficient and safe in the inpatient setting. Penicillin allergy de-labeling is important to reduce the burden of these labels on the patient’s care, health care professional’s decision making, and hospital systems.

Authors:

• Ellen Minaldi, MD – A/I
• Allison Norton, MD – A/I
• James Antoon, MD – PHM
• Ritu Banerjee, MD - ID
• Daniel Dulek, MD - ID