{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:14:39Z","timestamp":1780658079678,"version":"3.54.1"},"reference-count":40,"publisher":"Oceanside Publications Inc.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["allergy asthma proc"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Less than 5% of children who report penicillin allergy have clinically pertinent type 1 immunoglobulin E mediated hypersensitivity reaction by using direct oral amoxicillin challenge. Several pathways have been developed to delabel penicillin allergy by using\n direct oral amoxicillin challenge, mostly in the outpatient settings, but there is relative scarcity on published outcomes of these pathways, especially in the inpatient pediatric settings.  <jats:bold>Objective:<\/jats:bold> This study aimed to evaluate the performance of an institutionally derived\n inpatient penicillin allergy screening tool.  <jats:bold>Methods:<\/jats:bold> Patients were stratified into three penicillin allergy risk categories by using an institutional screening questionnaire. Patients with a no-risk status were delabeled without challenge testing. Patients with low-risk\n status underwent direct graded oral amoxicillin challenge and delabeled based on their response. Patients with high-risk status were referred to allergy service.  <jats:bold>Results:<\/jats:bold> Ninety-two patients were identified with penicillin allergy. Forty of the 92 patients (43%) were screened.\n Of the 40 patients screened, 6 (15%) were identified as no risk, 28 (70%) were identified as low risk, and 6 (15%) were identified as high risk. Twenty-four of the 28 patients at low risk (86%) were eligible for direct amoxicillin oral challenge. Seventeen of the 24 (71%) consented to oral\n challenge but only 12 (71%) underwent direct amoxicillin oral challenge. Eleven of the 12 who underwent oral challenge (92%) were successfully delabeled. Five of the six patients at no risk (83%) were successfully delabeled. Three of the six patients at high risk (50%) were referred for further\n allergy evaluation. Overall, 16 of the 40 patients screened (40%) were successfully delabeled.  <jats:bold>Conclusion:<\/jats:bold> In this small pediatric inpatient study, our institutional risk stratification screening tool identified patients at low risk for penicillin allergy and direct graded\n oral amoxicillin challenge was safely administered to delabel penicillin allergy in these patients.Clinical trial NCT05020327, &lt;ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\"&gt;www.clinicaltrials.gov&lt;\/ext-link&gt;<\/jats:p>","DOI":"10.2500\/aap.2024.45.230069","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T04:39:42Z","timestamp":1703738382000},"page":"61-69","source":"Crossref","is-referenced-by-count":9,"title":["Inpatient allergy delabeling of pediatric patients with low-risk penicillin allergy status through direct oral amoxicillin challenge"],"prefix":"10.2500","volume":"45","author":[{"given":"Peter Paul C.","family":"Lim","sequence":"first","affiliation":[{"name":"From the Division of Infectious Diseases, Department of Pediatrics, Avera McKennan University Health Center and Sanford University of South Dakota School of Medicine, Sioux Falls, South Dakota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LeAnne N.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pharmacy, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nori Mercuri","family":"Minich","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn Ruda","family":"Wessell","sequence":"additional","affiliation":[{"name":"Division of Allergy and Immunology, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankita P.","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1355","reference":[{"key":"B1","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"},{"key":"B2","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1093\/jac\/dky575","article-title":"Implementation of a pharmacist-led penicillin 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