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Figure 3 has been evaluated by paediatric allergists, an antimicrobial stewardship pharmacist, a general paediatrician, and paediatric infectious disease specialists.
Just over 60% of subjects found to be non-allergic by an allergist on the same day as their clinic appointment could have been identified as low-risk based on history alone, using the questionnaire and following this algorithm.
No patient identified as low risk was later diagnosed as allergic by an allergist, which demonstrates the
safety and reliability of this clinical tool. Figure 3: Algorithm to identify paediatric patients at low risk for penicillin allergy is available as a supplementary file .
Guiding principles for beta-lactam allergy in the paediatric population. Individuals with a history of suspected penicillin reaction but who have since tolerated one course of the medication are not allergic.
These antibiotics can be prescribed again without monitoring dose administration. Individuals at low risk for penicillin allergy can safely have the medication prescribed again.
Mild, delayed exanthems do not contraindicate further use of these antibiotics. Administration of a single test dose of amoxicillin (15 mg/kg) with a 1-hour observation period can provide reassurance and confirm that no allergy is present.
These individuals can be prescribed cephalosporins (with similar and dissimilar side
chains), carbapenems, and monobactams, without monitoring dose administration. Individuals with suspected IgE-mediated allergy should not be prescribed penicillin. They must be referred to a paediatric allergist for assessment.
For individuals with suspected IgE-mediated allergy, avoid prescribing cephalosporins with similar side chains. Cephalosporin medications with dissimilar side chains can be prescribed. When necessary (e.g., for patients who require frequent antibiotics for a chronic disease), or when a certain cephalosporin is desirable, a provocative challenge to
the specific cephalosporin a treatment team would like to use, can be conducted. Individuals who have experienced severe systemic or cutaneous delayed adverse reactions following a dose of penicillin, should not be prescribed this antibiotic in the future.
They must be referred to a paediatric allergist for assessment and counselling. There is no robust evidence to indicate cross-reactivity between specific penicillins or penicillins and cephalosporins with similar side chains in severe delayed allergic reactions.
Future decisions for penicillin use other than the ones implicated should be based on benefit versus risk assessment on a case-by-case basis.
Some organizations recommend avoiding cephalosporins with similar side chains in such cases  .
Individuals who have been diagnosed with penicillin allergy by an allergist should be re-assessed by a paediatric
allergist after 5 years.
This allergy can be outgrown and avoiding penicillin for life may not be necessary. This practice point was reviewed by the Community Paediatrics and Infectious Disease and Immunization Committees of the Canadian Paediatric Society, and co-authored by two members of the CPS Drug Therapy and Hazardous Substances Committee, Drs. CANADIAN PAEDIATRIC SOCIETY ALLERGY SECTION Executive members: Elissa M.
Chan MD (Secretary-Treasurer) Principal authors: Tiffany Wong MD, Adelle Atkinson MD, Geert t’Jong MD, Michael J.
Revised nomenclature for allergy for
global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003.
Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Abrams EM, Wakeman A, Gerstner TV, Warrington RJ, Singer AG. Prevalence of beta-lactam allergy: A retrospective chart review of drug allergy assessment in a predominantly pediatric population. Allergy Asthma Clin Immunol 2016;12:59 Gomes ER, Brokow K, Kuyucu S, et al.
Drug hypersensitivity in children: Report from the pediatric task force of the EAACI Drug Allergy Interest Group.
Allergy 2016;71(2):149-61 Mill C, Primeau MN, Medoff E, et al. Assessing the diagnostic properties of a graded
oral provocation challenge for the diagnosis of immediate and nonimmediate reactions to amoxicillin in children. Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics.
A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients.
Health care use and serious infection prevalence associated with beta-lactam “allergy” in hospitalized patients: A cohort study.
J Allergy Clin Immunol 2014;133:790e796 Trubiano JA, Thursky KA, Stewardson AJ, et al.
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