Penicillin Allergy in the MUSC Pediatric Emergency Department 


Video Presentation


Penicillin (PCN) allergy is commonly reported among Pediatric Emergency Department (PED) patients. Although antibiotics (ABX) can be a cause of life-threatening immune-mediated drug reaction, studies have shown many reported allergies to be inaccurate, with subsequent testing revealing no true allergy. PCN allergy displaces use of appropriate first-line treatments with broad-spectrum and non-beta-lactam ABX. This exposes patients to increased side effects, adverse events, and cost, and can lead to ABX resistance. Identification and testing of patients with inaccurate PCN allergy present an opportunity to address these issues and improve overall patient care.    

As part of a quality improvement initiative to address PCN allergy, we sought to define the overall burden of PCN allergy within the PED. With this data we hope to design an intervention to address PCN allergy for PED patients, with emphasis on identifying and testing patients with likely inaccurately-listed allergy.     

We performed an EPIC query of current pediatric patients to determine the overall prevalence of PCN allergy; our needs population. We identified patients with PCN allergy who had a PED visit in the past year, our convenience group, as well as those patients with prior Allergy encounters as a surrogate for potential prior PCN allergy evaluation. We further reviewed listed PCN allergy symptoms to estimate those with likely low-risk symptoms that may be amenable to ED-based testing.

2,239 current pediatric patients with listed PCN allergy were identified.  Among these, allergy severity was listed as high in 566 (25.3%), medium in 279 (12.5%), and low in 730 (32.6%). Closer evaluation of reported symptoms demonstrated potentially low-risk symptoms in as many as 1,295 patients (57.8%), with only 213 patients (9.5%) listing anaphylaxis, angioedema, or shortness of breath. Of all patients with listed PCN allergy, only 113 (5.0%) had a prior listed Allergy clinic encounter. 213 (9.5%) had a PED visit within 2018.   

A large number of pediatric patients within the MUSC system have a listed PCN allergy.  Of these, only a small fraction has established care with the MUSC Allergy department, indicating their PCN allergy has likely not been addressed.  The PED saw approximately ten percent of these patients in the past year, and as such could serve a valuable role in closing this differential.  Of those patients with PCN allergy, over fifty percent had potentially low-risk symptoms that may be amenable to an ED-based screening and testing initiative.