Section of Pediatric Emergency Medicine and
Division of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Pediatrics. 2018 May;141(5). doi: 10.1542/peds.2017-3466.
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.
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.
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 $192 223.00.
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.
青霉素过敏在儿科急诊室中较为常见。我们之前对低风险症状的儿童进行了 3 级青霉素过敏测试，且 100%的儿童在接受青霉素挑战时未出现过敏反应。我们假设再次接触青霉素不会发生严重过敏反应，并且测试后处方实践会发生改变。
我们对 100 名青霉素过敏测试结果为阴性的儿童进行了后续病例系列研究。研究人员对每位接受测试的患者的家长和初级保健提供者进行了简短的随访电话调查。我们合并了调查数据，并总结了基线患者特征和问卷应答。然后，我们根据从调查中收集的处方信息完成了 3 级经济分析，其中计算了成本节约、成本避免和潜在成本节约。
在接受青霉素过敏测试后的一年内，初级保健提供者和/或家长报告了 36 名患者中的 46 个处方。其中 26 个（58%）处方为青霉素衍生物。有 1 名（4%）儿童在开始用药 24 小时后出现皮疹，但没有儿童在接受青霉素挑战后发生严重不良反应。我们发现，将患者从青霉素过敏标签中去除的成本节约为 1368.13 美元，成本避免为 1812.00 美元，儿科急诊部门人群的总潜在成本节约为 192233.00 美元。
低风险青霉素过敏症状且青霉素过敏测试结果为阴性的儿童在接受青霉素挑战时未发生严重过敏反应。将儿童从青霉素过敏标签中去除改变了处方行为并带来了实际的医疗保健节约。
