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Adverse clinical outcomes in children due to antibiotic allergy labels

Published online: September 18, 2018

Antibiotic allergy labelling is a substantial and growing public health concern and it is known that adult patients with antibiotic allergy labels experience worse clinical outcomes than those without labels. The objective of this study was to investigate the impact of antibiotic allergy labelling on the clinical outcomes in children.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Lucas et al describe a retrospective study conducted in a major pediatric tertiary hospital to capture 1,672 inpatient admissions in April 2014 and April 2015.  Data collected by chart review included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.  

Antibiotic allergies were recorded in 5.3% of the cohort. Beta-lactams were implicated in the majority of cases (N=75), of which penicillin was most commonly reported. As age increased, individuals were more likely to have any antibiotic allergy label and, more specifically, a beta-lactam allergy label. Children were more likely to report an allergy to one antibiotic rather than allergies to multiple antibiotics. There was no difference in rate of antibiotic allergy labels when stratified by gender. The presence of an antibiotic allergy label (any allergy label, a beta-lactam, or penicillin allergy label) was significantly associated with prescription of alternative antibiotics. Among children currently receiving antibiotics (N=749 patients) those with antibiotic allergy labels received significantly more macrolides, quinolones, lincosamides, and nitroimidazoles than those not labelled as allergic to antibiotics. After adjusting for patient age, sex, principal diagnosis, and admission specialty, any antibiotic allergy label was associated with increased hospital length of stay.

The reported use of broad-spectrum antibiotics for allergy-labelled children with sometimes trivial infections is concerning, as these antibiotics should be reserved for serious infections. In the study cohort, 46 (52.3%) children with a penicillin or amoxicillin allergy reported mild to moderate reactions (rashes) and could potentially have been directly de-labelled following oral provocation challenge. The authors suggest that this simple strategy could mitigate the adverse clinical outcomes observed.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Antibiotic Allergy Labels in Children Are Associated with Adverse Clinical Outcomes
By Michaela Lucas, MD, Annabelle Arnold, DipHE, Aine Sommerfield, PhD, Michelle Trevenen, BSc, Laure Braconnier, PhD, Alina Schilling, Fuad Abass, MD, Lliana Slevin, BSc, Brittany Knezevic, MBBS, Christopher Blyth, PhD, Kevin Murray, PhD, Britta von Ungern-Sternberg, MD, PhD, Kristina Rueter, MD