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Outpatient and primary care direct provocation challenges for antibiotic allergy in children
  1. Anjum Grewal1,2,
  2. Nicola Jay1,2
  1. 1Paediatric Allergy, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  2. 2School of Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Dr Anjum Grewal, Paediatric Allergy, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK; Anjum.Grewal{at}


Objective To evaluate the use of a questionnaire-based decision-making algorithm to triage children with reported antibiotic allergies to proceed directly to an oral provocation challenge.

Design Cohort study.

Setting Children aged 2–16 years attending paediatric emergency department over 1 year (1 June 2018 till 31 May 2019) or identified from four primary care centres in Sheffield with a recorded antibiotic allergy and no previous testing.

Participants 313 children with 325 recorded antibiotic allergies.

Exposure Clinical decision-making algorithm used to either exclude, directly delabel or stratify children to oral antibiotic challenge in outpatient department or primary care practice.

Main outcome measures To assess the safety of using the questionnaire-based algorithm for proceeding to a direct oral provocation challenge.

The secondary outcomes were to look for associations and predictive factors in positive challenges and to assess parent/carer acceptability of the service by using Likert Scale.

Results Successful contact was made with 200 children, of which 153 children could be evaluated based on inclusion criteria, engagement and availability of medical records.

15 children were directly delabelled based on history and records. 138 children underwent challenges in outpatient and primary care. 6% of challenges were reactive with a mild, delayed reaction. Overall, a delabelling rate of 91% was achieved. There were no clear predictors for a positive challenge.

Conclusion Our questionnaire-based algorithm for stratifying children with antibiotic allergies to proceed directly to an oral outpatient or primary care challenge was found to be safe, feasible and acceptable.

  • Allergy and Immunology
  • Paediatrics
  • Primary Health Care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors NJ planned and designed the study. The study was conducted by AG under the guidance of NJ. AG collated data and wrote initial drafts of the manuscript which were revised by NJ.

    NJ as the guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.