Removing false labels of penicillin allergy from pediatric medical records


At the 2023 American Academy of Pediatrics National Conference & Exhibition, Paul V. Williams, MD, FAAP, explains his session "Tell Me it Ain't So: Delabeling Penicillin Allergy," and how general pediatricians can make a difference by removing a false penicillin allergy label from a child's medical record.

Interview highlights

  • The discussion aimed to persuade pediatricians to identify patients with false penicillin allergy labels, allowing for their removal and enabling the future use of penicillin, promoting responsible antibiotic use.
  • Around 20% of patients have penicillin allergy labels, but only 5% are genuinely allergic. Misunderstood symptoms and family history often lead to these false labels, which persist from childhood into adulthood.
  • Pediatricians can educate parents about the rarity of true penicillin allergies and the safety of in-office challenges, confirming that 95% of labeled patients aren't allergic. However, studies show limited proactive action, with few patients referred for allergy testing.
  • Delabeling false penicillin allergies is vital to reduce unnecessary antibiotic use, adverse effects, hospital stays, and healthcare costs. Education of both healthcare providers and patients is essential to address this issue effectively.

Interview transcript (edited for clarity):

Contemporary Pediatrics®:

Why did you want to discuss penicillin allergy labels at the 2023 American Academy of Pediatrics National Conference & Exhibition?

Paul V. Williams, MD, FAAP:

The whole purpose was to try and convince primary care pediatricians that they can help us in finding all these patients who have false labels for penicillin allergy and remove that label from their medical records so that they can use that drug in the future.

Contemporary Pediatrics:

How does a false penicillin label happen?


The interesting thing is the label is usually applied in childhood, and then nobody does anything about it, it remains with that patient until they're an adult, to the point that up to 20% of patients seeking medical care will have a penicillin allergy label, but only 5% of those will be truly penicillin allergic. The problem with that is that they start using, because they have that penicillin allergy label, more expensive broad spectrum antibiotics, which leads to more adverse effects, longer hospital stays, cost more money, more resistant organisms, all of those things happen. For antibiotic stewardship purpose, we want to find out who's truly allergic and avoid it in that group, but let's delabel as we call it, that 95% of those patients who aren't truly allergic. But you ask why does that happen,and there are a lot of reasons why. Some people will think "there's a family history of penicillin allergy, so I don't want my child to have penicillin," So they say they're allergic to penicillin, or they had symptoms that weren't probably due to an allergy, so they're more intolerant to the drug than allergic to the drug, but just for convenience sake, so people don't use it again, they'll put down allergic to penicillin. Sometimes the reaction isn't known. So since you don't have a history, you want to play it safe. So you put down an allergy label, or they get some sort of rash when they've got this viral infection and they're being treated with antibiotics for convenience or safety will put that label on them, but never do anything about it. So that label sticks.

Contemporary Pediatrics:

How can the general pediatrician play a role in reducing false allergy labels? What can they say to parents?


I think you have to explain that 95% of the people that thinks they're allergic to penicillin truly aren't. You have to explain to them what the ramifications of having that penicillin allergy label is and the safety of doing a challenge in the office, it's extremely safe. Only 5% of people will react even of the low risk people, you may get about 5% that have a mild reaction. So you can identify 95% of the people that aren't allergic to penicillin. You can take that drug in the future. Most of the studies looking at pediatric challenge if you've done in preschool age kids, and so that's when it starts and nothing's ever done about it. That label stays on the chart, they never get tested or challenged or anything like that. There was a recent study in Pediatrics that looked at how many pediatricians are doing something about this and it was like 15% get referred to an allergist and only 10% of those end up going, the rest they ignore. So, it's not happening and we got a big push to try and get this done.

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