Penicillin Allergy Often Overdiagnosed in Children

Children with parent-reported penicillin allergy symptoms and categorized as low risk for immunoglobulin E-mediated hypersensitivity likely do not have true penicillin allergy, according to a recent study.

Penicillin allergy is commonly reported in the pediatric emergency department (ED). However, true penicillin allergy is rare, and the diagnosis tends to result from denial of first-line antibiotics.
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A total of 597 parents of children aged 4 years to 18 years presenting to the pediatric ED completed a questionnaire describing their child’s allergy symptoms. Each child had a history of parent-reported penicillin allergy.

Of these 597 children, a total of 302 (51%) children were categorized as low risk for penicillin allergy based on parent-reported symptoms, and were eligible for testing. The researchers defined low risk of penicillin allergy as having low risk of immunoglobulin E-mediated hypersensitivity. Rash and itching were the most common parent-reported allergy symptoms.

Of the 302 children, a total of 100 were tested for penicillin allergy with a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval. Median age at allergy diagnosis was 1 year, and median age at testing was 9 years.

Testing showed that all 100 children had negative results for penicillin allergy. As a result, penicillin allergy was removed from their medical records.

“All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy,” the researchers concluded. “The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics.”

—Christina Vogt

Reference:

Vyles D, Adams J, Chiu A, Simpson P, Nimmer M, Brousseau DC. Allergy testing in children with low-risk penicillin allergy symptoms. Pediatr. 2017. doi:10.1542/peds.2017-0471.