Student Research Assistant Connecticut Children's Medical Center East Granby, Connecticut, United States
Background: When receiving antibiotics, up to 10% of children will develop rashes and many labeled as an allergy. In the presence of a true antibiotic allergy, children are expected to exhibit an IgE-mediated reaction. Roughly 90% of children labeled as penicillin-allergic do not have an IgE-mediated reaction representative of a true allergy when given an oral challenge. Providers in the emergency department (ED) may prescribe second line antibiotics for children labeled with antibiotic allergies. PEN_FAST is a simple tool to help identify people with low risk criteria for a true penicillin allergy but has not been reported for use to identify patients at low risk with other antibiotics. Objective: 1. To assess the proportion of patients labeled with antibiotic allergies who are at low risk of having true IgE mediated allergies
2. To determine how often children with exclusively low-risk allergy symptoms are prescribed second-line antibiotics. Design/Methods: Parents of children with documented antibiotic allergies presenting to a pediatric ED were approached and asked to complete a survey including demographic information, specific offending antibiotic, PEN-FAST items (validated measure for assessing risk of true Ig-E mediated reactions). PEN-FAST decision rule scores range from 0-6, with < 3 considered low risk.
This clinical decision rule utilizes 3 clinical criteria of time since allergy episode, phenotype, and need for reaction treatment. The PEN-FAST clinical decision rule was selected for this study as limited metrics for measuring penicillin allergy have been published and validated, and the items can be easily asked in the clinical setting. Results: This study is currently in progress, with 95 subjects enrolled. However, only 18% were prescribed antibiotics during or at discharge. Additional subjects are needed to answer the second objective and we expect to enroll at least 100 additional subjects within the next 2 months. Amoxicillin was the most common cause of an allergic reaction, with 54% of participants reporting that it caused a reaction. Hives were the most reported symptom, with 75.9% of respondents reporting hives.
Conclusion(s): Preliminary findings indicate that the majority of children labeled with penicillin allergies likely do not have a true IgE-mediated allergy. Few children with other antibiotic allergies have been enrolled, about 14.9%. Initial data suggests that a significant proportion of all children exhibit only low-risk allergy symptoms, reinforcing the need for reevaluation of their antibiotic allergy.
