J Pediatr. 2025 Oct 23:114867. doi: 10.1016/j.jpeds.2025.114867. Online ahead of print.
ABSTRACT
In a retrospective cohort from two pediatric referral centers, we demonstrate that direct amoxicillin challenges appear to be safe in infants and toddlers with a non-high risk penicillin allergy label. Our data support expanding the benefits of early penicillin allergy delabeling to this population. Penicillin allergy labels (PALs) are the most common pediatric drug allergy label and are associated with numerous adverse clinical outcomes as well as negative public health and economic implications.1-3 Direct drug challenge has emerged as an important tool to evaluate penicillin allergies in both children and adults.4-6 For adults, recent index reactions within the preceding 5 years have been identified as a risk factor for positive penicillin testing and is included in a validated risk stratification tool, PEN-FAST. 3 However, PEN-FAST was not validated in children and overall performs poorly in this population.7 Studies specifically assessing the safety and efficacy of direct amoxicillin challenges to evaluate PALs in children under the age of 5 years are lacking. In this study, we evaluate the safety and efficacy of direct amoxicillin challenges in the evaluation of infants and toddlers with a PAL.
PMID:41139013 | DOI:10.1016/j.jpeds.2025.114867
