Validity of Self-Reported Penicillin Allergies in a Community Paediatric Population
CPS ePoster Library. Hoe E. Jun 25, 2015; 99257; 196
Erica Hoe
Erica Hoe
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Abstract
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Background
About 10% of people claim to have a penicillin allergy. In the current literature, most patients with negative skin tests can tolerate oral doses of penicillin and only 1.2% of patients experience IgE-mediated reactions. Verifying a penicillin allergy is important because it reduces patient exposure to other antibiotics that are associated with increased patient morbidity and healthcare costs.

Objectives
The aim of this study is to report the validity of self-reported penicillin allergies in paediatric patients presenting to an allergy clinic as determined by the results of skin testing, intradermal testing with penicillin and 5-day oral dose challenges of amoxicillin.

Design/Method
This is a retrospective chart review of 284 patients who presented to an allergy clinic for penicillin allergy assessment. Data was collected from patients who received skin testing and intradermal testing of penicillin and a subsequent 5-day oral dose challenge of amoxicillin from April 2011 to December 2014. Patients were first given skin and intradermal testing. Patients with positive skin or intradermal tests were not given oral amoxicillin due to possible life-threatening reaction. Those whose reactions were negative to skin and intradermal testing went on to receive a 5-day oral dose challenge of amoxicillin. Patients with history of serum sickness or Steven-Johnson syndrome/TENS were excluded from this clinic. This study is associated with low risk ethics as all patient identifying information will be undisclosed.

Results
8.1% (23 of 284) of self-reported penicillin allergies reacted positively to allergic testing as determined by a positive skin test, intradermal testing or 5-day oral challenge. There were 6 reactions to skin and intradermal testing, and these patients did not go on to receive oral doses of amoxicillin. Of those who received the oral challenge, a small number of patients (5 of 284) reacted within 24 hours of ingestion of the first dose of amoxicillin, which could be attributed to an IgE-mediated allergic reaction. A majority of patients (12 of 284) had a delayed reaction with a rash occurring 24 hours after initial ingestion penicillin. Of the oral challenges, the reactions included 6 with hives, 11 with a rash, and none with any cardiopulmonary compromise. There were no patient characteristics identified that were associated with a positive allergy test.

Conclusion
In our community paediatric population, of those reporting a penicillin allergy, only 8.1% were proven to be allergic. Of these, the majority had a delayed reaction to penicillin, which typically only involved a rash. Penicillin allergy testing is important as it can help determine whether patients should actually be avoiding penicillin. It may be useful to adopt a skin-testing regimen within hospitals to identify penicillin allergies. Of those who test negative to skin testing, it is unlikely that they will react to oral penicillin in a life-threatening manner. This can help reduce the use of other antibiotics, which are known to increase hospital stay and antibiotic-resistant infections.
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