Children Admitted to Hospital with Parent-Reported Allergies to Antibiotics Have Worse Outcomes

Child in Hospital

According to a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, pediatric hospital patients who were reported as allergic to antibiotics by their parents fared worse in clinical outcomes than similar patients who were not designated allergic.

Researchers in Australia reviewed the charts of 1672 inpatient admissions at a major pediatric hospital during the year beginning April 2014. The data included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.

Of the patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients, the majority of which were mostly to unspecified penicillins.

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Though no gender effect was seen, there was an increasing incidence of the antibiotic allergy label with age. Patients labeled with antibiotic allergy received more macrolide, quinolones, lincosamide antibiotics as well as metronidazole than patients without the antibiotic allergy label.

After adjusting for patient age, sex, principal diagnosis and admitting specialty, children labeled with any antibiotic or beta-lactam allergy had longer hospital lengths of stay with a mean length of 5.2 days versus 3.8 days without the label.

More than 90% of antibiotic allergy labels are inaccurate, noted Dr Michaela Lucas of The University of Western Australia in Nedlands, the study’s first author. “True antibiotic allergy occurs in approximately 5%-10% of children. To distinguish a child with a true allergy from those who can consequently tolerate the antibiotic, the child will need to undergo formal allergy assessment.”

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“Once a reaction occurs, it is difficult at the time to know what really caused it. Parents are told to stop the antibiotic and from then on will report that their child had a reaction to an antibiotic. The child will retain this ‘label’ into adulthood, as follow-up for the presumed allergy is not commonly arranged,” Dr. Lucas said.

“Clear-cut and practical steps to assess antibiotics that can be applied in primary care are needed,” she added. “There is a cost to misapplied antibiotic allergy labels in children and thus labels based on historical reports should be confirmed in childhood to reduce the burden of reported, but unconfirmed antibiotic allergies in our hospitals.”

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