Reported Knowledge and Management of Potential Penicillin Allergy in Children. Acad Pediatr 2019 Aug;19(6):684-690
Date
02/01/2019Pubmed ID
30703582DOI
10.1016/j.acap.2019.01.002Scopus ID
2-s2.0-85063442775 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
BACKGROUND: Pediatric emergency medicine (PEM) and primary care provider (PCP) providers are the most likely physicians to initially label a child as allergic to penicillin. Differences in knowledge and management of reported penicillin allergy between these 2 groups have not been well characterized.
METHODS: A cross-sectional, 20-question survey was administered to PEM and PCPs to ascertain differential knowledge and management of penicillin allergy. Knowledge regarding high- and low-risk symptoms for true allergy and extent of history taking regarding allergy were compared between the 2 groups using t tests, Chi-square, and Wilcoxon tests.
RESULTS: In total, 182 PEM and 54 PCPs completed the survey. PEM and PCPs reported that 74.1 ± 19.5% and 69.0 ± 23.8% of patients with remote low-risk symptoms of allergy could tolerate penicillin without an allergic reaction. PEM and PCPs incorrectly identified low-risk symptoms of allergy as high-risk, including vomiting with medication administration and delayed skin rash. PCPs took more detailed allergy histories when compared with PEM providers. In total, 143 (78.5%) of PEM providers and 51 (94.4%) PCPs were interested in using a penicillin allergy questionnaire to segregate children into high- or low-risk categories.
CONCLUSIONS: Most pediatric providers believe that children with a remote history of low-risk allergy symptoms could tolerate penicillin without an allergic reaction; however, this is infrequently acted upon. Both PEM and PCP providers were likely to classify low-risk symptoms as high-risk and infrequently referred children for further detailed allergy assessment. Both groups were receptive to decision support measures to facilitate improved penicillin allergy classification and labeling and support antibiotic appropriateness in their patients.
Author List
Vyles D, Mistry RD, Heffner V, Drayna P, Chiu A, Visotcky A, Fraser R, Brousseau DCAuthors
Asriani M. Chiu MD Professor in the Pediatrics department at Medical College of WisconsinPatrick C. Drayna MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Raphael Fraser PhD Assistant Professor in the Medicine department at Medical College of Wisconsin
Viday Heffner MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Alexis M. Visotcky Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAnti-Bacterial Agents
Cross-Sectional Studies
Drug Hypersensitivity
Emergency Service, Hospital
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Pediatrics
Penicillins
Physicians
Surveys and Questionnaires
Wisconsin
