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Testing in Children with Low-Risk Penicillin Allergy

Pediatrics; ePub 2017 Jul 3; Vyles, Adams, et al

Publish date:

All children presenting to a pediatric emergency department (ED) and categorized as low-risk for penicillin allergy were found to have negative results for true penicillin allergy, a recent study found. Parents of children aged 4 to 18 years and with a history of parent-reported penicillin allergy completed an allergy questionnaire upon presenting to the pediatric ED. 100 children categorized as low-risk based on reported symptoms completed penicillin allergy testing using a standard 3-tier testing process. Researchers found:

  • 597 parents completed the questionnaire describing their child’s reported allergy symptoms.
  • 302 (51%) children had low-risk symptoms and were eligible for testing; 100 were tested for penicillin allergy.
  • Rash and itching were the most common allergy symptoms.
  • Overall, 100 (100%) children were found to have negative results for penicillin allergy.

Citation:

Vyles D, Adams J, Chiu A, Simpson P, Nimmer M, Brousseau DC. Allergy testing in children with low-risk penicillin allergy symptoms. [Published online ahead of print July 3, 2017]. Pediatrics. doi:10.1542/peds.2017-0471.

Commentary:

It is common for parents to report a penicillin allergy for their child, and the reasonable reason is typicially to avoid penicillin and related antibiotics from that point forward. Often, the history of penicillin allergy has a low likelihood of actually being an allergy and is based on symptoms such as GI discomfort or a small rash. The problem with this approach is that it takes important and commonly used antibiotics off the map, leaving a limited number of other, often more broad spectrum antibiotics for use. Previous studies have shown that penicillin skin testing is a safe method to exclude penicillin allergy in children.1 Penicillin allergy testing is often carried out by first doing a percutaneous skin test, followed
 by the more sensitive intracutaneous testing, and then an oral drug challenge. This study defined low-risk as including reported symptoms of penicillin allergy that were not actually likely to be due to an allergic IgE response such as a mild maculopapular rash, itching, diarrhea, vomiting, runny nose, nausea, and cough. High-risk symptoms included skin reaction with angioedema, anaphylaxis, wheezing, or diffuse erythema. This study suggests that it may be reasonable to refer children whose history is consistent with a low likelihood of serious penicillin allergy to an allergist for allergy testing rather than excluding use of penicillin and cephalosporins indefinitely. —Neil Skolnik, MD

  1. Fox SF, Park MA. Penicillin skin testing is a safe and effective tool for evaluating penicillin allergy in the pediatric population. J Allergy Clin Immunol Pract. 2014;2(4):439–444.
  2. Centers for Disease Control and Prevention. Management of persons who have a history of penicillin allergy. https://www.cdc.gov/std/treatment/2010/penicillin-allergy.htm. Accessed July 15, 2017.

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