Parental perspective on penicillin allergy delabeling in a pediatric emergency department

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

“…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.…”

“…[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.…”

“…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.…”