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Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study


Objective To evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).

Design One-year quality improvement study using a before–after design.

Setting Free-standing tertiary care paediatric hospital.

Patients Patients with a reported beta-lactam allergy admitted to the paediatric medicine inpatient unit.

Interventions Following standardised assessment and risk stratification of reported symptoms, patients with a low-risk history were offered an OPT. Beta-lactam allergy labels were removed if a reported history was considered non-allergic or after successful OPT.

Main outcome measures Removal of inappropriate beta-lactam allergy labels.

Results 80 patients with 85 reported beta-lactam allergies were assessed. Median age was 8.1 years (IQR 4.8–12.9) and 34 (42%) were female. The majority (n=55, 69%) had an underlying medical condition. Amoxicillin was the most reported allergy (n=25, 29%). Reported reactions were primarily dermatological (n=65, 77%). Half of participants (n=40) were ineligible for OPT, with equal proportions due to clinical reasons or the nature of the reported reaction. Of the 40 eligible patients, 28 patients (70%) were de-labelled either by history alone (n=10) or OPT (n=18). All OPTs were successful. De-labelling allowed five additional patients (11% of those receiving antibiotics) to receive the preferred beta-lactam. Including patients who were subsequently assessed in the allergy clinic, almost half of all evaluated patients were de-labelled (n=37, 46%).

Conclusions An antimicrobial stewardship programme-led programme using a direct OPT was feasible and safe for expanding beta-lactam allergy de-labelling to paediatric patients admitted to the paediatric medicine inpatient unit.

  • Paediatrics
  • Allergy and Immunology
  • Infectious Disease Medicine

Data availability statement

Data are available upon reasonable request. Deidentified participant data that underlie the results will be available following publication. Researchers who provide a scientifically sound proposal will be allowed access to the aggregate participant data. Proposals should be directed to or These proposals will be reviewed and approved by the investigator and collaborators on the basis of scientific merit.

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