1. True Rate of Allergy among Pediatric Inpatients with Penicillin Allergy Labels (TRIAL).
- Author
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Kwan N, Kang K, Carr RR, Mak R, Roberts A, Jin F, Bone JN, Rassekh SR, and Wong T
- Abstract
Background: Penicillin allergy is a common drug allergy diagnosis in pediatric patients; however, upon appropriate allergy testing, many of these patients are found not to have a true allergy. For patients with a reported allergy, alternative antibiotics are prescribed, which are less effective, more toxic, or more expensive. There is a lack of data evaluating allergies in hospitalized children and comparing allergy assessments conducted by pediatric allergists and pharmacists., Objective: To estimate the percentage of pediatric patients admitted with reported penicillin allergy who did not have a true penicillin allergy., Methods: This single-centre prospective cohort study included inpatients between 6 months and 17 years of age, with a documented penicillin allergy, who were admitted to the general pediatric and oncology units of a tertiary care children's hospital between November 2019 and March 2023. The allergy history, evaluation, and risk categorization were performed by pharmacists. The history was reviewed with the allergist, and the patient was then referred, underwent skin testing, or received oral amoxicillin challenge with monitoring for 1 hour., Results: Thirty patients were included, of whom 29 (97%) had delabelling of their penicillin allergy. Four patients (13%) had delabelling on the basis of history alone, without risk assessment. Twenty-five (83%) of the patients were assessed as having low risk; 24 of these had delabelling following oral challenge, and 1 did not complete the oral challenge because of transfer to another hospital. One patient (3%) was assessed as having moderate risk, with delabelling on the basis of results of skin testing and oral challenge. The pharmacist's and allergist's risk assessments were in agreement in 29 (97%) of the 30 cases., Conclusions: Pediatric patients, including those with oncologic malignancies, are often mislabelled as having a penicillin allergy. Pharmacists are able to accurately determine true allergy risk and delabel penicillin allergies for pediatric patients in the hospital setting., Competing Interests: Competing interests: For activities unrelated to the study reported here, Raymond Mak has received speaker’s honoraria from ALK, Sanofi, CSL Behring, Pfizer, AstraZeneca, and Novartis; and Tiffany Wong has received speaker’s honoraria from Valeo, Pfizer, CeraVe, and Polaris Health. Dr Wong also serves as Faculty Lead for the Spread Quality Improvement initiative of the Provincial Health Services Authority (British Columbia) and Faculty Lead for Patient Safety and Quality Improvement, Postgraduate Medical Education, Faculty of Medicine, The University of British Columbia. No other competing interests were declared., (2024 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.)
- Published
- 2024
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