Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pediatric and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Ann Allergy Asthma Immunol. 2020 Jun;124(6):558-565. doi: 10.1016/j.anai.2020.03.012. Epub 2020 Mar 26.
To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children.
Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review.
Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label.
This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy.
Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.
回顾与报告青霉素过敏的儿童相关的文献，强调儿童去标签的不同方法，并评估青霉素过敏对儿童的公共卫生影响。
本综述的数据通过 PubMed 检索获得，并从其相应期刊中检索文章进行进一步审查。
通过 PubMed 检索确定了评估儿童青霉素过敏安全性的不同方法的研究。凡是报告了不同测试方法（3 级、直接口服挑战、5 天口服挑战）的研究均被纳入。在选择与青霉素过敏标签相关的成本、处方模式和管理趋势相关的相关文章时，也采用了相同的格式。
本综述发现，青霉素过敏测试是一种安全有效的去标签方法，可用于报告过敏的儿童。对于低风险过敏症状的儿童，直接口服挑战方法可能是最佳选择。对于有高风险过敏症状史的儿童，3 级方法是理想的。综述还发现，报告的青霉素过敏存在显著的成本，对报告过敏的儿童存在增加的负面健康影响。
青霉素过敏被过度诊断，通常是不正确的，而且该标签通常是在儿童时期首次贴上的。针对儿童去除不正确的青霉素过敏标签提供了一种机制，可以减少广谱和效果较差的抗生素的使用。
