The study will identify pediatric patients 3-18 years old who have penicillin allergy label
in the electronic medical record. Those who are identified will be stratified into no-risk,
low-risk and high-risk category using a screening questionnaire. The following definitions
will be followed:
No-risk: Patients who are historically labeled with penicillin allergy in the EMR based on
family history alone OR those who have tolerated penicillin after a concerning incident
without any reaction OR with penicillin allergy label but deny any history of reaction to any
form of penicillin on screening questionnaire
Low-risk: Patients with previous reaction not suggestive of anaphylaxis (defined below) AND
not requiring hospitalization for the reaction OR reaction considered non- immunologic (e.g.
diarrhea, nausea, yeast vaginitis) OR exposure to penicillin- containing antibiotic after the
date of reported reaction with no anaphylaxis and hospitalization AND no serious types of
delayed reactions such as Steven- Johnson syndrome (SJS), toxic epidermal necrolysis (TEN),
acute interstitial nephritis (AIN), drug-induced hepatitis or other documented organ injury,
drug rash eosinophilia systemic symptoms (DRESS), hemolytic anemia, drug-induced cytopenia,
and serum sickness. Patients who had delayed reaction (onset more than 24 hours) of isolated,
non-progressive symptoms (such as rash/hives alone) also belong to this group.
High-risk: Patients with penicillin allergy label on EMR with previous reaction suggestive of
anaphylaxis (defined below) OR requiring hospitalization/epinephrine administration for the
reaction OR reactions considered immunologic (angioedema, joint pains) OR involving serious
types of reactions such as Steven-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN),
acute interstitial nephritis (AIN), drug-induced hepatitis or other documented organ injury,
drug rash eosinophilia systemic symptoms (DRESS), hemolytic anemia, drug-induced cytopenia,
and serum sickness. Patients who were previously diagnosed with penicillin allergy by an
allergist also belong to the high-risk group.
Patients in the no-risk group will be immediately delabeled. Patients in the high-risk group
will be referred to allergy/immunology for further work up. The focus of this study is to
identify the patients who belong to the low-risk group. This group of patients will be
subjected to graded oral amoxicillin challenge testing. Those who will have reactions
compatible with allergy will have their allergy status retained in the electronic medical
record. Those that will not have reactions or those that will have reactions that are not
compatible with allergy will be delabeled in the electronic medical record.