{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:22:09Z","timestamp":1793020929297,"version":"4.5.0"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Penicillin allergy is commonly reported in the pediatric emergency department. We previously performed 3-tier penicillin allergy testing on children with low-risk symptoms, and 100% tolerated a penicillin challenge without an allergic reaction. We hypothesized that no serious allergic reactions would occur after re-exposure to penicillin and that prescription practices would change after testing.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We performed a follow-up case series of 100 children whose test results were negative for penicillin allergy. Research staff administered a brief follow-up phone survey to the parent and primary care provider of each patient tested. We combined the survey data and summarized baseline patient characteristics and questionnaire responses. We then completed a 3-tier economic analysis from the prescription information gathered from surveys in which cost savings, cost avoidance, and potential cost savings were calculated.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n A total of 46 prescriptions in 36 patients were reported by the primary care provider and\/or parents within the year after patients were tested for penicillin allergy. Twenty-six (58%) of the prescriptions filled were penicillin derivatives. One (4%) child developed a rash 24 hours after starting the medication; no child developed a serious adverse reaction after being given a penicillin challenge. We found that the cost savings of delabeling patients as penicillin allergic was $1368.13, the cost avoidance was $1812.00, and the total potential cost savings for the pediatric emergency department population was $192\u2009223.00.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction developing. Delabeling children changed prescription behavior and led to actual health care savings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2017-3466","type":"journal-article","created":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T03:25:14Z","timestamp":1524194714000},"source":"Crossref","is-referenced-by-count":59,"title":["Antibiotic Use After Removal of Penicillin Allergy Label"],"prefix":"10.1542","volume":"141","author":[{"given":"David","family":"Vyles","sequence":"first","affiliation":[{"name":"Section of Pediatric Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asriani","family":"Chiu","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Routes","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Castells","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Harvard University and Brigham and Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Kibicho","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Brousseau","sequence":"additional","affiliation":[{"name":"Section of Pediatric Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2018,5,1]]},"reference":[{"issue":"4","key":"2021121021515395300_B1","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/S0889-8561(05)70036-9","article-title":"Adverse reactions to \u03b2-lactam antibiotics.","volume":"18","author":"Mendelson","year":"1998","journal-title":"Immunol Allergy Clin North Am"},{"key":"2021121021515395300_B2","first-page":"S498","article-title":"\u03b2-lactam antibiotics: the diagnosis and management of anaphylaxis.","volume":"101","author":"Nicklas","year":"1999","journal-title":"J Allergy Clin Immunol"},{"issue":"6784","key":"2021121021515395300_B3","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1136\/bmj.302.6784.1051","article-title":"Allergy to penicillin: fable or fact?","volume":"302","author":"Surtees","year":"1991","journal-title":"BMJ"},{"issue":"1","key":"2021121021515395300_B4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1742-1241.1994.tb09729.x","article-title":"Penicillin allergy: a study of incidence as reported by patients.","volume":"48","author":"Kerr","year":"1994","journal-title":"Br J Clin Pract"},{"issue":"3","key":"2021121021515395300_B5","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1398-9995.1984.tb02619.x","article-title":"Penicillin allergy\u2014can the incidence be reduced?","volume":"39","author":"Ahlstedt","year":"1984","journal-title":"Allergy"},{"issue":"18","key":"2021121021515395300_B6","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1001\/archinte.160.18.2819","article-title":"The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance.","volume":"160","author":"Lee","year":"2000","journal-title":"Arch Intern Med"},{"issue":"5","key":"2021121021515395300_B7","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1001\/archinte.1992.00400170105020","article-title":"Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults.","volume":"152","author":"Sogn","year":"1992","journal-title":"Arch Intern Med"},{"issue":"3","key":"2021121021515395300_B8","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jaci.2013.09.021","article-title":"Health care use and serious infection prevalence associated with penicillin \u201callergy\u201d in hospitalized patients: a cohort study.","volume":"133","author":"Macy","year":"2014","journal-title":"J Allergy Clin Immunol"},{"issue":"2","key":"2021121021515395300_B9","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S0091-6749(98)70097-1","article-title":"Elective penicillin skin testing and amoxicillin challenge: effect on outpatient antibiotic use, cost, and clinical outcomes.","volume":"102","author":"Macy","year":"1998","journal-title":"J Allergy Clin Immunol"},{"issue":"3","key":"2021121021515395300_B10","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.acap.2016.11.004","article-title":"Parent-reported penicillin allergy symptoms in the pediatric emergency department.","volume":"17","author":"Vyles","year":"2017","journal-title":"Acad Pediatr"},{"issue":"2","key":"2021121021515395300_B11","doi-asserted-by":"crossref","first-page":"e20170471","DOI":"10.1542\/peds.2017-0471","article-title":"Allergy testing in children with low-risk penicillin allergy symptoms.","volume":"140","author":"Vyles","year":"2017","journal-title":"Pediatrics"},{"issue":"2","key":"2021121021515395300_B12","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2021121021515395300_B13","unstructured":"Centers for Disease Control and Prevention; 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