Delabeling Penicillin Allergy in A Pediatric Primary Care Clinic.

PURPOSE OF THE STUDY: To evaluate the feasibility and safety of a novel strategy of performing direct amoxicillin-graded oral challenge (GOC) in a pediatric general practitioner office in a prospective pilot study. STUDY POPULATION: Children aged 2 to 17 years old with emergency medical record-listed penicillin allergy labels were recruited from Children's Health Medical Center of Dallas between December 2021 and October 2022. METHODS: Once eligibility was confirmed (excluding those with history of severe cutaneous adverse reaction phe-notypes), patients underwent a 2-step nonblinded GOC with amoxicillin 50 mg followed by a 200 mg dose with a 10-minute interval in between doses and a 60-minute observation period performed during routine health care maintenance visits. RESULTS: Eighty-six of the initial 112 (77%) screened were deemed eligible for participation. Twenty-three proceeded on to the challenge (21%). Of the 23 that underwent GOC, 21 passed without any reaction (91%). Of the 2 with reactions, 1 was an immediate erythematous macule, and the other patient had a delayed mild maculopapular exan-them that occurred approximately 4 hours after completion of the challenge. Both reactions were nonurticarial and improved with oral antihistamine therapy. All (100%) of the parents and caregivers reported satisfaction with the amoxicillin challenge testing, and all patients who completed the challenge without any reaction said they would CONCLUSIONS: This pilot study supports known data that most children who are labeled to have penicillin allergy are indeed not allergic when challenged, but also offers a novel process for completing in-office challenges by primary care physicians. Importantly, it supports evidence that direct GOC to amoxicillin is safe and parents and care-givers of those challenged are satisfied with the procedure and are likely to use penicillin antibiotics in the future if needed. [ABSTRACT FROM AUTHOR]