Penicillin allergy documentation uninformative in allergy tabs

Allergy tabs have uninformative penicillin allergy documentation, and children are infrequently referred to allergists, according to a recent study.

Penicillin allergy labels are the most common allergy labels, making it important to address when labels are inappropriate. These labels increase hospital duration, adverse drug event rates, and healthcare costs among pediatric patients.

Negative penicillin skin testing andoral amoxicillin are likely in penicillin allergic children, and the American Academy of Allergy, Asthma, and Immunology has urged physicians not to, “overuse non beta lactam antibiotics in patients with history of penicillin allergy, without an appropriate evaluation.”

To measure the quality of penicillin allergy labels and the rate of penicillin allergy referrals, investigators reviewed a chart of children from a dual-center pediatric birth cohort given a penicillin allergy label in the first decade of life. There were 500 children born from January 1, 2010 to June 30, 2020 labeled as penicillin allergic selected for the analysis.

Data was gathered from patients’ electronic medical records, including basic demographics, medications, healthcare encounters, and allergy tab documentation. The nature of an inciting adverse drug event, the outcomes of penicillin allergy evaluations, and the negative effects of re-exposure to penicillin in delabeled children were analyzed.

The reaction characteristics and timing in the allergy tab and remaining healthcare notes and encounters were used to determine allergy risk classification.

Physicians placed 62.7% of penicillin allergy labels, while medical assistants placed 13.4%, nurses 11.4%, and advanced practice providers 8.2%. Amoxicillin was the most common penicillin class antibiotic allergy at 73.6%, followed by amoxicillin-clavulanate at 13.4%, and penicillin at 13%. The median age of labelling was 1.4 years.

Rash was the most common adverse event reported at 44.6%, followed by hives at 32.2%, and no documented reaction at 16.2%. Penicillin allergy label risk classification was only determined in half of the patients, with the most common classification being, “moderate or high risk.”

Reactions were reported in a median 6 days. Evaluation occurred at a primary care clinic within 7 days for 78% of children, while 14.7% had evaluation within 24 hours at an emergency or urgent care center and 10.9% discussed their reaction over telephone. Persistent symptoms more than 24 hours after stopping medication were seen in 42% of patients.

Referral to an allergist for penicillin allergy evaluation was seen in 16.8% of patients, while an allergist saw 10.8% of patients during the study period. Five percent of patients underwent penicillin skin testing, and none had a positive skin test.

Reference

Taylor MG, Joerger M, Anvari S, Gerber JS, Palazzi DL. The quality and management of penicillin allergy labels in pediatric primary care. Pediatrics. 2023;151(3). doi:10.1542/peds.2022-059309