RT Journal Article
SR Electronic
T1 Barriers to paediatric penicillin allergy de-labelling in UK secondary care: a regional survey
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 363
OP 366
DO 10.1136/archdischild-2022-324564
VO 108
IS 5
A1 Kene Maduemem
A1 Hannah Clark
A1 Iseult Sohal
A1 Tom Dawson
A1 Niten Makwana
A1 ,
YR 2023
UL http://adc.bmj.com/content/108/5/363.abstract
AB Background Incorrect penicillin allergy labels result in the use of inappropriately broad-spectrum antibiotics. De-labelling inaccurate penicillin allergy promotes antimicrobial stewardship and optimises prescribing practices. The objectives were to evaluate paediatric clinicians’ knowledge and understanding of penicillin allergy and to identify barriers in tackling incorrect penicillin allergy labels.Methods Paediatric clinicians from across the West Midlands of the UK were surveyed using an online, anonymised questionnaire between 1 August and 30 September 2021. Domains explored were (1) approach to penicillin allergy clinical vignettes, (2) knowledge of the impact of penicillin allergy labels, (3) frequency of allergy-focused history questions and (4) barriers in tackling incorrect penicillin allergy.Results Responses were received from 307 paediatric clinicians across 12 hospitals. Sixty-one per cent would not prescribe a penicillin-based antibiotic if a family history of penicillin allergy was reported. There was an overall deficit in taking an allergy-focused history with only 36.5% inquiring about diagnostic confirmation. Absence, or lack of awareness of a referral pathway for antibiotic allergy evaluation (58.6%) and unfamiliarity of the indications for oral provocation testing (55%) were the most common reported barriers to penicillin allergy de-labelling. Fifty-one per cent would rather ‘play it safe’ than explore penicillin allergy confirmation as it is felt that alternative treatments were readily available.Conclusions The deficiency in antibiotic allergy-focused history among paediatric clinicians highlights the need for better allergy education across all clinical grades. Pragmatic algorithms and clear referral pathways could address barriers faced by non-allergists in de-labelling incorrect penicillin allergy.Data are available upon reasonable request. Data available upon request.