In two major U.S. pediatric networks, penicillin allergy labels were judged to be “uninformative,” researchers report, “and children were infrequently referred to allergists. Future quality improvement studies should improve penicillin allergy documentation and expand access to allergy services.”
Charts with penicillin allergy labels of 500 randomly selected children, chosen from 18,015 children born in 2010–2020, were classified as “not allergy,” “low risk,” “moderate or high risk,” “severe risk,” or “unable to classify” based on documentation within the allergy tab and electronic healthcare notes. Those findings and outcomes of allergy referrals and penicillin re-exposure produced these results: “Half of penicillin allergy labels were ‘unable to classify’ based on allergy tab documentation. Risk classification agreement between allergy tabs and healthcare notes was fair (Cohen’s ĸ = 0.35 ± 0.02). Primary care physicians referred 84 of 500 (16.8%) children to an allergist, but only 54 (10.8%) were seen in allergy clinic. All children who were challenged (25 of 25) passed skin testing. Removal of allergy labels was uncommon (69 of 500, 13.8%) but occurred more often following allergy appointments (26 of 54, 48%) than not (43 of 446, 9.6%, P < .001). Children delabeled by primary care physicians were as likely to tolerate subsequent penicillin-class antibiotics as those delabeled by an allergist (94% vs 93%, P = .87).”