357 - Parental Perspectives on Penicillin Allergy Delabeling in a Pediatric Emergency Department

Poster Number: 357
Publication Number: 357.205

Cheryl Yang, University of Utah School of Medicine, Salt Lake cITY, UT, United States; Cheryl Yang, University of Utah School of Medicine, Salt Lake City, UT, United States; Jessica Graham, Ochsner Hospital for Children, Salt Lake City, UT, United States; Jan Leonard, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Chisom Agbim, Children's Hospital Colorado, Aurora, CO, United States; David Vyles, Medical College of Wisconsin, Milwaukee, WI, United States; Rakesh MIstry, University of Colorado School of Medicine, Aurora, CO, United States

Background: Penicillin (PCN) allergy is often mislabeled in children who do not have true IgE-mediated reactions. Questionnaire-based de-labeling processes using historical measures have recently been developed. The pediatric emergency department (PED) is a proposed location for processes to identify and de-label PCN allergic children at low-risk for true IgE-mediated allergy. Understanding parental perspectives in PED-based allergy de-labeling is crucial for implementation in this setting.

Objective: To describe parental perspectives on allergy de-labeling in the PED for children identified as low-risk for true PCN allergy.

Design/Methods: Cross-sectional survey of parents of children with documented PCN allergy presenting to a single tertiary-care PED. Parents were approached for survey completion in the PED if their child had PCN allergy documented in the medical record. The survey used an established questionnaire to stratify children as low- or high-risk for true PCN allergy; we subsequently assessed barriers to PED de-labeling, and factors that increased willingness to oral challenge and de-label low-risk children in the PED.

Results: Of 198 children, 49 (25%) screened low-risk for true PCN allergy. The majority of participants reported rash (92%); of those, 113 (62%) screened high-risk due to rash occurring within 6 hours. Of the 49 low-risk children, comfort with allergy de-labeling was variable (Table). A total of 29 (59%) parents were uncomfortable with PCN oral challenge during PED visit. Reasons cited included fear of allergic reaction (72%), adequate alternative antibiotics (45%), and longer PED stay (17%). Willingness to de-label included PCN's low side effect profile (65%) and avoidance of emerging bacterial resistance from alternative antibiotic use (74%). Participants without family history (FH) of PCN allergy were more comfortable with PCN oral challenge in the ED (60% vs. 11%; p = 0.001) and allergy de-labeling (67% vs. 37%; p = 0.04) compared to those with FH. There was no difference among parental de-labeling comfort levels by the age at diagnosis, race/ethnicity, or parental education.Conclusion(s): Most parents of low-risk PCN allergic children are uncomfortable with oral challenge or de-labeling in the PED. Prior to implementing oral challenges in PEDs, efforts should be made to highlight the safety of oral challenging low-risk children, the benefits and risks of alternative antibiotics, and the minimal impact that FH has on PCN allergy.
Table 1. Comfort with oral challenge and de-labeling among parents of low-risk children (N = 49)