First pediatric electronic algorithm to stratify risk of penicillin allergy
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Allergy, Asthma & Clinical Immunology
LETTER TO THE EDITOR
Open Access
First pediatric electronic algorithm to stratify risk of penicillin allergy Hannah Roberts1* , Lianne Soller2, Karen Ng3, Edmond S. Chan2, Ashley Roberts4, Kristopher Kang5, Kyla J. Hildebrand2 and Tiffany Wong2
Abstract Beta-lactam allergy is reported in 5–10% of children in North America, but up to 94–97% of patients are deemed not allergic after allergist assessment. The utility of standardized skin testing for penicillin allergy in the pediatric population has been recently questioned. Oral drug challenges when appropriate, are preferred over skin testing, and can definitively rule out immediate, IgE-mediated drug allergy. To our knowledge, this is the only pediatric study to assess the reliability of a penicillin allergy stratification tool using a paper and electronic clinical algorithm. By using an electronic algorithm, we identified 61 patients (of 95 deemed not allergic by gold standard allergist decision) as low risk for penicillin allergy, with no false negatives and without the need for allergist assessment or skin testing. In this study, we demonstrate that an electronic algorithm can be used by various pediatric clinicians when evaluating possible penicillin allergy to reliably identify low risk patients. We identified the electronic algorithm was superior to the paper version, capturing an even higher percentage of low risk patients than the paper version. By developing an electronic algorithm to accurately assess penicillin allergy risk based on appropriate history, without the need for diagnostic testing or allergist assessment, we can empower non-allergist health care professionals to safely de-label low risk pediatric patients and assist in alleviating subspecialty wait times for penicillin allergy assessment. Keywords: Amoxicillin, Antibiotics, Pediatrics, Penicillin, Allergy, Anaphylaxis, Infection Main text To the editor, Beta-lactam allergy is reported in 5–10% of children in North America [1–3], but up to 94–97% of patients are deemed not allergic after allergist assessment [4–6]. Reasons for the disparity between perceived and true drug allergy include predictable antibiotic side effects and symptoms of underlying infection, frequently mistaken for adverse drug reaction. Recently, the utility of standardized skin testing for penicillin allergy in the pediatric population has been questioned as recent literature has demonstrated that penicillin skin testing *Correspondence: [email protected] 1 Division of Allergy and Immunology, Department of Medicine, Western University, St. Joseph’s Health Care, 268 Grosvenor St, London, ON N6A 3N3, Canada Full list of author information is available at the end of the article
in pediatric patients can be less predictive of risk of IgE-mediated allergy [7]. Oral drug challenges are the gold standard in definitively ruling out immediate, IgEmediated drug allergy [6]. Given the high demand for allergist assessment for perceived penicillin allergy (which in most cases is erroneously
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