Penicillin Allergy Delabeling Clinical Pathway

Penicillin antibiotics such as amoxicillin, an aminopenicillin, are commonly used to treat infections in children including otitis media, strep throat, and pneumonia. However, a penicillin allergy is reported by up to 10% of the population in the United States. Penicillin allergies are over-diagnosed and over 90% of patients with a reported penicillin or amoxicillin allergy do not have a reaction when testing is performed. This is likely due to inappropriate initial allergy diagnosis or resolution of the allergy over time. Having a penicillin allergy label in the medical record can limit access to preferred antibiotic treatment options, contribute to adverse health outcomes, and promote antimicrobial resistance. 

Single dose amoxicillin challenges have been established as a safe and effective tool for the evaluation of penicillin allergy in pediatric patients who are considered low risk for a severe reaction. The Penicillin Allergy Delabeling Clinical Pathway outlines an approach to assist clinicians in identifying patients who would be eligible to undergo an amoxicillin challenge for evaluation of penicillin allergy as well as steps to perform an amoxicillin challenge in a variety of clinical settings.

Penicillin Allergy Delabeling Clinical Pathway

• Penicillin Allergy Delabeling

About our Penicillin Allergy Delabeling Clinical Pathway

The Penicillin Allergy Delabeling Clinical Pathway was created by an expert group of pediatric allergy specialists at the Children’s Hospital Colorado in consultation with clinicians from a variety of clinical settings including hospital medicine (inpatient), the Emergency Department and Urgent Care, and primary care (outpatient). 

The Clinical Pathway was originally implemented in 2019 to provide an evidence-based guide to assist hospital medicine physicians in identifying and delabeling inappropriate penicillin allergies among low-risk patients who were admitted. Simultaneously, the Allergy Clinic at the Children’s Hospital Colorado began performing single dose amoxicillin challenges during routine outpatient allergy clinic visits. To date, over a thousand patients have now successfully undergone amoxicillin challenge at the Children’s Hospital Colorado. No patients have developed severe adverse reactions or required emergent treatment with epinephrine.