All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics.

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Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below: Review the target audience, learning objectives and all disclosures. Complete the pre-test. Read the article and reflect on all content as to how it may be applicable to your practice. Key Messages All individuals with an unconfirmed penicillin allergy should have their penicillin allergy evaluated and, if appropriate, tested to confirm current hypersensitivity or tolerance. All individuals with a penicillin-associated history of anaphylaxis, rash, gastrointestinal symptoms, headaches, other low-risk symptoms, an unknown history, or a reported family history of penicillin allergy can undergo testing to confirm current tolerance and convince the patient that penicillins can safely be used. The reference standard test to confirm current penicillin class antibiotic hypersensitivity or tolerance is an oral challenge with a therapeutic dose, typically 250 mg for adults, and 1 hour of observation to confirm acute tolerance, followed by 5 days of at home follow-up to confirm the absence of clinically significant T-cell−mediated delayed-onset hypersensitivity. Low-risk individuals, with penicillin reaction histories that are unlikely to be IgE mediated, can safely go to a direct oral amoxicillin challenge with a therapeutic dose to confirm current tolerance. Puncture and intradermal skin testing using only penicilloyl-polylysine, with at least 5 mm of wheal and flare greater than wheal as the criteria for a positive test result, is now sufficient to rule out a high risk of having anaphylaxis during a confirmatory oral amoxicillin challenge. Individuals with positive skin test results should not undergo oral challenges and, like individuals with immediately positive oral challenge results, undergo oral penicillin desensitization if they have a documented infection for which a penicillin is the drug of choice.

Children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction developing. Delabeling children changed prescription behavior and led to actual health care savings.