Parental Report of Penicillin Allergy: Is it Reliable?

July 10, 2017

Parental Report of Penicillin Allergy: Is it Reliable?

  1. Deborah Lehman, MD

Testing did not confirm penicillin allergy in any of 100 children with parent-reported penicillin allergy and low-risk symptoms.

  1. Deborah Lehman, MD

Antibiotic allergy is commonly reported in pediatric patients, and is usually based on parental history rather than allergy testing. When allergy is reported, an alternative, and sometimes broader, antibiotic is usually prescribed. Allergy to penicillin is the most commonly reported antibiotic allergy, and testing to confirm parental or patient history is available but rarely done.

Researchers identified nearly 600 children ages 3 to 18 years who presented to a single urban emergency department over a 19-month period and had history of parent-reported penicillin allergy. Parents completed a questionnaire about penicillin allergy symptoms; based on the responses, the researchers classified 434 children as having low-risk symptoms (non IgE mediated symptoms, including rash, itching, diarrhea, vomiting, runny nose, nausea, cough; or reported family history of allergy) and 163 as having high-risk symptoms (e.g., anaphylaxis or other IgE-mediated symptoms).

The first 100 interested and available children with low-risk symptoms underwent standard 3-tier allergy testing: percutaneous skin testing followed by intracutaneous skin testing and oral amoxicillin challenge. No child was found to be allergic based on 3-tier testing; 3 children (3%) had a reaction to the percutaneous component of testing.

Comment

Results of this small study suggest that children with low-risk, non IgE-mediated penicillin allergy symptoms can safely be given penicillin. Physicians should review the child's clinical symptoms when a parent reports penicillin allergy and consider prescribing a penicillin antibiotic if the symptoms are low risk.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Editorial boards NEJM Knowledge+ Leadership positions in professional societies American Academy of Pediatrics; PREP The Course (Planning Committee Member)

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