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Penicillin Allergy in Children Substantially Overreported

Most children with parent-reported symptoms of penicillin allergy have negative results for a true allergic reaction to the drug, a new study shows.

“Our results showed that the majority of children had rash and itching as their primary reported symptom of allergy,” the authors write. “Consistent with our hypothesis, all children with symptoms deemed to be low risk for true [immunoglobulin E (IgE)]-mediated drug hypersensitivity ultimately had negative results for true penicillin allergy after the standard 3-tier testing process.”

 Penicillin allergy is the most frequently reported drug allergy, and its reporting affects how clinicians treat affected patients.

According to the authors, although many children present to the pediatric ED with parent-reported symptoms of penicillin allergy, most of these symptoms are low risk for true reaction.

However, because clinicians in the pediatric ED cannot safely and quickly diagnose true penicillin allergy, they avoid giving penicillin to children with a reported penicillin allergy. Thus, many children are not receiving optimal antibiotic treatment because of penicillin allergy misdiagnosis.

The gold standard for diagnosing penicillin allergy comprises a three-tier testing process, in which a percutaneous skin test is followed by more sensitive intracutaneous testing and an oral drug challenge.

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