Barriers to penicillin allergy delabeling in a pediatric emergency department

Graham, Jessica; Yang, Cheryl C.H.; Vyles, David; Leonard, Jan; Mistry, Rakesh D.

doi:10.1016/j.anai.2021.09.018

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Moreover, some authors examined the agreement between the interview of the patients and the medical records of the hospital charts or of thee ED, but did not include children 42–47 . A survey by Yang et al 2 . was conducted at a pediatric ED, where parents were asked to complete a questionnaire to classify high‐risk and low‐risk children: 25% were screened as low‐risk, but more than half of their parents felt uncomfortable to undergo a challenge at the ED.…”

Section: Discussionmentioning

confidence: 99%

“…[38][39][40][41] Moreover, some authors examined the agreement between the interview of the patients and the medical records of the hospital charts or of thee ED, but did not include children. [42][43][44][45][46][47] A survey by Yang et al 2 was conducted at a pediatric ED, where parents were asked to complete a questionnaire to classify high-risk and low-risk children: 25% were screened as low-risk, but more than half of their parents felt uncomfortable to undergo a challenge at the ED. Among studies with a described allergy work-up in children, Gomes et al 22 showed a frequency of self-reported suspected HR of 6%, but after allergy investigation only 3/60 (5%) had a confirmed diagnosis.…”

Section: Characteristics Of the Patients And Their History Of Reactionmentioning

confidence: 99%

“…De-labeling suspected HRs is fundamental, especially in pediatric age, when events occurring frequently (such as viral exanthemas and nonallergic minor side effects) lead to the application of an inappropriate "allergy label" without performing a complete allergy work-up. [2][3][4][5][6] Various approaches for de-labeling are reported in the literature, [7][8][9][10] even by exploiting history alone, trying to perform risk stratification based only on the medical history. 11 Currently, the greatest limitation of this pathway is the risk of faulty memories or mistakes.…”

Section: Introductionmentioning

confidence: 99%

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The importance of clinical history in the diagnosis of drug hypersensitivity in children

Liccioli,

Tomei,

Pessina

et al. 2024

Pediatric Allergy Immunology

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BackgroundIn case of suspected hypersensitivity reactions (HRs) to drugs, a challenging area for pediatricians is detecting relevant elements in the parent‐reported history, in order to reach a definite diagnosis. We analyzed the concordance between the description of the HR and the medical reports documented at the time of the event. Furthermore, we studied any correlation between clinical history variables and the prediction of true allergy.MethodsWe retrospectively collected 50 charts of children referred to our Allergy Unit, after a previous access to the Emergency Department. We compared the description of the HR at acute phase to the history told by parents. Type and timing of the HR and culprit drug were classified as “known” or “unknown.” The diagnosis was confirmed or excluded at the end of the investigations. Logistic regression analysis was performed to find any significant association.ResultsThe type of the HR was known in 74%, the timing in 28%, and the culprit drug in 98%. We showed that having had a severe HR had an increased odds of remembering the timing; being older >6 years and having had an immediate HR had an increased odds of remembering the type; time to diagnostic was lower in patients whose parents remembered the type of HR.ConclusionOur paper underlines the importance of an accurate anamnesis at the time of the event. Providing the physicians with a standardized Case Report Form could be a useful tool to simplify the diagnostic work‐up and minimize mistakes due to lack of memory.

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Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of the Patients And Their History Of Reactionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The importance of clinical history in the diagnosis of drug hypersensitivity in children

Liccioli,

Tomei,

Pessina

et al. 2024

Pediatric Allergy Immunology

View full text Add to dashboard Cite

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“…In this regard, some authors recommend delabeling patients with a reported beta-lactam allergy through a multidisciplinary approach involving medical specialists in allergy, infectious diseases, internal medicine, emergency medicine, and pharmacists [13]. In addition, delabeling methods have been proposed to address misclassi ed betalactam allergies, promote antimicrobial stewardship, optimize outcomes, and reduce costs [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings

Sobrino-García,

Muñoz-Bellido,

Moreno-Rodilla

et al. 2024

Int J Clin Pharm

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BackgroundPatients with a penicillin allergy label have an associated increase in adverse antibiotic events and hospitalization costs. AimWe aimed to study the economic savings derived from the correct diagnosis and delabeling of inpatients with suspected beta-lactam allergy. MethodWe prospectively evaluated patients admitted to the University Hospital of Salamanca who had been labeled as allergic to beta-lactams and performed a delabeling study on them. Subsequently, the difference in costs between the antibiotics administered before and after the allergy study and between the costs derived from those patients who received alternative antibiotics during admission and those who switched to beta-lactams after the allergy study were calculated. ResultsOne hundred seventy-seven inpatients labeled as allergic to beta-lactams underwent a delabeling study, and 34 (19.2%) of them were con rmed to have an allergy to beta-lactams. Of the total number of patients, 136 (76.8%) received antibiotic treatment during their hospitalization involving a mean (SD) cost of €203.07 (318.42). After delabeling, in 85 (62.5%) patients the antibiotic treatment was changed to beta-lactams. In this group of patients, the mean cost (SD) then decreased from €188.91 (351.09) before the change to 91.31 (136.07) (p < 0.001) afterward, so the mean cost (SD) total decreased in these patients to €142.07 (200.50), p = 0.000. This cost reduction was also signi cant when compared to the mean (SD) cost of patients in whom treatment was not changed to beta-lactams (€226.66 (256.43)) (p < 0.001). ConclusionsDelabeling hospitalized patients, when possible, represents a cost-saving measure for treating patients labeled as allergic to beta-lactams.

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Parental perspective on penicillin allergy delabeling in a pediatric emergency department

Yang

Graham

Vyles

et al. 2023

Annals of Allergy, Asthma & Immunology

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Barriers to penicillin allergy delabeling in a pediatric emergency department

Cited by 4 publications

References 9 publications

The importance of clinical history in the diagnosis of drug hypersensitivity in children

The importance of clinical history in the diagnosis of drug hypersensitivity in children

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings

Parental perspective on penicillin allergy delabeling in a pediatric emergency department

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