Barriers to Pediatric Penicillin Allergy De-labelling in UK Secondary Care: A Regional Survey

To evaluate pediatric clinicians’ understanding of true penicillin allergy traits and identify barriers to penicillin allergy delabeling.

The study included 307 pediatric clinicians of varying provider levels in the West Midlands region of the United Kingdom recruited through the Pediatric Research Across the Midlands Network.

Participants completed an anonymous online questionnaire assessing their knowledge of penicillin allergy, its impact on patients, oral drug provocation tests, and barriers to delabeling. Responses were scored on a 5-point Likert scale and analyzed using descriptive statistics through SPSS V.25.0. Associations were evaluated using Fisher’s exact or ×2 test, with P value < .05 considered statistically significant.

61% of pediatricians would not prescribe a penicillin-based antibiotic if there were a positive family allergy history. Ninety five percent of participants asked about reaction symptoms. However, only 57% asked about the onset of symptoms from the time of penicillin ingestion, and only 60% asked if they had tolerated it since the reaction. Only 36.5% of clinicians said they would verify if penicillin allergy were a confirmed diagnosis. Significant barriers to penicillin delabeling included a lack of awareness of antibiotic allergy referral pathways (58.6% of clinicians) or the use of oral challenges for allergy confirmation (55%). Fifty percent stated they would rather “play it safe” than explore penicillin allergy confirmation since alternative treatments were readily available. Of participants, 7.2% did not consider penicillin allergy delabeling as their responsibility.

This survey completed by various pediatric clinicians demonstrated gaps and barriers in penicillin allergy history-taking and delabeling.

Penicillin allergy is the most reported drug allergy in the United States. One in 10 patients report a penicillin allergy, but 90% do not have a true allergy. Penicillin allergy labeling proves harmful to patients by requiring the use of less effective and more costly second-line antibiotics, resulting in their overuse, and increasing the risk of antimicrobial resistance. Additional evidence shows that patients who do not receive β-lactams, when indicated, have higher hospital admission rates and a greater risk of mortality. Strategies proposed to address penicillin delabeling include clear referral pathways for drug allergy evaluation, skin testing and oral challenges, and decision support tools to improve allergy documentation and labeling. This study highlights the need for educating pediatric providers on penicillin allergy labeling and testing for true drug allergy. The paper also emphasizes the importance of obtaining a thorough drug allergy history and the valuable role general pediatricians can play in penicillin delabeling.