How common are penicillin allergies in pediatrics?

An allergy to penicillin is the most common allergy to a prescription drug. And, because it will be noted in a patients’ record, it may influence the plan a clinician makes to treat a bacterial disease. An investigation looked into what elements are linked to the labelling of penicillin allergies in pediatric offices.¹

The retrospective, longitudinal study was performed in 90 pediatric clinics in Austin, Texas; Houston, Texas; Philadelphia, Pennsylvania; and parts of New Jersey. Children were included in the cohort if they were born between January 2010 and June 2020; had a visit during the first 14 days of life; and had at least 2 more visits within the first year at one of the clinics. The primary outcome was the addition of penicillin allergy labelling to the patient’s electronic health record, including penicillin derivatives such as ampicillin, amoxicillin, piperacillin-tazobactam, amoxicillin-clavulanate, ampicillin-sulbactam, or antistaphylococcal penicillin. Those with isolated cephalosporin and carbapenem allergies were not included in this group.

There were 334,465 children in the birth cohort of which 18,015 had a penicillin allergy label. The prevalence of the label ranged from 0.9% to 10.2% across the practices. Then median age when children were given the label was 1.3 years. After controlling for possible confounders, the investigators found that non-Hispanic White children were more likely to receive a penicillin allergy label than non-Hispanic Black children (adjusted odds ratio [aOR], 1.7 [95% CI, 1.6-1.8]). Patients who had been given at least 1 penicillin prescription before age 2 years were more likely to be labeled than children who had not (aOR, 1.7 [95% CI 1.6-1.8]) . A total of 6797 allergic children received a label after being prescribed 1 penicillin treatment and 1423 were labeled after receiving no penicillin prescriptions.

The investigators confirmed that a penicillin allergy label was common in pediatrics, with a wide variation. Many children were noted as allergic early in their life, with many being declared allergic to penicillin after just 1 prescription or even 0 prescriptions. They urged further research into the veracity of the label along with the outcomes tied to the label.

Reference

1. Taylor M, Joerger T, Li Y, et al. Factors associated with penicillin allergy labels in electronic health records of children in 2 large US pediatric primary care networks. JAMA Netw Open. 2022;5(3):e222117. doi:10.1001/jamanetworkopen.2022.2117