Penicillin Allergy Delabeling in Children

Nearly 10% of the global population has been labeled as having a penicillin allergy. Of those labeled, about 95% are not truly allergic, yet most do not receive any allergy evaluations. Patients with penicillin allergy labels are more likely to have worse clinical outcomes and incur higher health care costs, largely because they do not receive penicillin and other first-line β-lactam antibiotics for the treatment of infectious diseases. Consequently, the process of evaluating and removing inaccurate penicillin allergy labels—a process known as “delabeling”—has become increasingly supported by a growing body of evidence. Recently, penicillin allergy has garnered substantial public interest with the proposal of federal legislation to include evaluation of penicillin allergy during routine medical visits for Medicare patients. Although this moves delabeling into the generalist purview, most of the emphasis on penicillin allergies and delabeling has been on adult patients. Yet, penicillin allergy is a pressing issue for pediatrics, as most penicillin allergy labels are placed in childhood. Pediatric literature similarly demonstrates negative clinical and public health consequences of inaccurate penicillin allergy labels. Recent guidelines have strongly recommended a proactive effort to identify and delabel inaccurate penicillin allergies in children. To facilitate this process, simple delabeling procedures, such as direct oral challenge with amoxicillin, have been recommended for patients with low-risk allergy status, based on historical reaction verification, because of their safety and accuracy. These advancements are relevant to practicing pediatricians across specialties and practice locations.