Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026
Direct single dose mass delabelling of antibiotic allergy in pediatrics.
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Coyne Sheena, Byrne Aideen, Gill Amber, Henderson Davina, Tedford Kara, Donald Victoria Mc, O'Connor Helen, Breen Catherine, Stafford Aisling, Kelleher Maeve, Coghlan David, Hourihane Jonathan
Аннотация
BACKGROUND: Unsubstantiated antibiotic allergy labels affect between 8% and 25% of the population worldwide. Current risk stratification tools, derived from adult data, are not validated for children. A simplified, multi-patient protocol with minimal exclusion criteria is required to tackle the scale of this public health issue.
METHODS: Patients with possible antibiotic allergy were recruited from the Children's Health Ireland (CHI) allergy waiting list. Exclusion criteria were a serum sickness like reaction (SSLR), severe cutaneous adverse reaction (SCARs), anaphylaxis, or non-allergic symptoms. No prior allergy testing was performed. Dosing was direct single observed dosing in dedicated mass delabelling clinics, followed by a two-day home antibiotic course.
RESULTS: Consenting patients (n = 162) were seen over 6 clinics with gradually increasing clinic sizes (Range 18 to 62, average 23). One patient only was excluded based on the severity of their index event. Average age was 7 years, n = 90/162 (55.6%) were female. Most were avoiding amoxicillin, n = 137/162 (84.6%). Negative challenge rates were similar to previous studies, n = 150/162 (92.6%), 3 had immediate reactions and 9 delayed (all non-severe). Patients retrospectively underwent risk stratification according to the 2024 EAACI position paper, high risk n = 38/162 (23.5%), intermediate risk n = 74/162 (45.7%) and low risk n = 50/162 (30.9%). Those deemed high risk were no more likely to have a positive challenge than those deemed low/intermediate risk (n = 2/38, 5.3% vs. n = 10/124, 8.1%, p = .56).
CONCLUSION: Antibiotic allergy delabelling in pediatrics is low risk and can be done safely in high patient load without prior allergy testing. Current risk stratification tools are not suitable for pediatric-specific models of care.
METHODS: Patients with possible antibiotic allergy were recruited from the Children's Health Ireland (CHI) allergy waiting list. Exclusion criteria were a serum sickness like reaction (SSLR), severe cutaneous adverse reaction (SCARs), anaphylaxis, or non-allergic symptoms. No prior allergy testing was performed. Dosing was direct single observed dosing in dedicated mass delabelling clinics, followed by a two-day home antibiotic course.
RESULTS: Consenting patients (n = 162) were seen over 6 clinics with gradually increasing clinic sizes (Range 18 to 62, average 23). One patient only was excluded based on the severity of their index event. Average age was 7 years, n = 90/162 (55.6%) were female. Most were avoiding amoxicillin, n = 137/162 (84.6%). Negative challenge rates were similar to previous studies, n = 150/162 (92.6%), 3 had immediate reactions and 9 delayed (all non-severe). Patients retrospectively underwent risk stratification according to the 2024 EAACI position paper, high risk n = 38/162 (23.5%), intermediate risk n = 74/162 (45.7%) and low risk n = 50/162 (30.9%). Those deemed high risk were no more likely to have a positive challenge than those deemed low/intermediate risk (n = 2/38, 5.3% vs. n = 10/124, 8.1%, p = .56).
CONCLUSION: Antibiotic allergy delabelling in pediatrics is low risk and can be done safely in high patient load without prior allergy testing. Current risk stratification tools are not suitable for pediatric-specific models of care.