Pilot Study of Direct Amoxicillin Challenges for Pediatric Penicillin Allergy Delabeling
Overview
This pilot study evaluated direct amoxicillin oral challenges conducted during pediatric group visits in primary care to assess penicillin allergy labels. Among 61 children challenged, 95% tolerated amoxicillin without reaction, and all positive reactions were mild and cutaneous, supporting the safety and feasibility of this approach.
Background
Penicillin allergy labels are common but often inaccurate, leading to suboptimal antibiotic use and increased antimicrobial resistance in children. Direct oral amoxicillin challenge without prior skin testing has emerged as a safe method to delabel most pediatric patients. However, barriers such as clinic time and staffing limit penicillin allergy testing availability in primary care. Group visits may optimize resources and improve access to allergy testing in pediatric settings.
Data Highlights
Parameter
Value
Number of children referred
120
Number of challenges completed
61
Median age at index reaction (years)
2 (IQR 1–3)
Median age at challenge (years)
11 (IQR 6–13)
Cutaneous-only index reaction
52 (85%)
Index reaction within 1 hour
18 (30%)
Challenges tolerated without reaction
58 (95%)
Positive challenge reactions
3 (5%)
Severity of positive reactions
Mild, cutaneous-only
Key Findings
Direct amoxicillin challenges in pediatric group visits resulted in 95% of children being safely delabeled from penicillin allergy.
All positive reactions were mild and limited to cutaneous symptoms, with no severe or anaphylactic reactions observed.
The median age at challenge was 11 years, with most index reactions occurring in early childhood (median 2 years).
Group visits facilitated efficient use of clinic resources and allowed pharmacist-driven testing within primary care pediatric clinics.
Families demonstrated willingness to participate in penicillin allergy testing conducted by their pediatrician in a group setting.
Clinical Implications
Direct oral amoxicillin challenges can be safely integrated into pediatric primary care group visits to effectively delabel penicillin allergies, improving antibiotic stewardship. This approach addresses common barriers such as limited clinic time and staffing by leveraging group visits and pharmacist-led protocols. Clinicians should consider implementing similar strategies to expand access to penicillin allergy testing and reduce unnecessary antibiotic avoidance.
Conclusion
This pilot study supports the feasibility and safety of pharmacist-driven direct amoxicillin challenges during pediatric group visits in primary care to delabel penicillin allergies. Further implementation studies are warranted to expand equitable access to penicillin allergy testing.
References
Authors et al. 2024 -- Pilot Study on Direct Amoxicillin Challenges for Assessing Penicillin Allergy During Pediatric Group Visits in Primary Care
