Children with reported penicillin allergy: Public health impact and safety of delabeling

Ann Allergy Asthma Immunol. 2020 Jun;124(6):558-565. doi: 10.1016/j.anai.2020.03.012. Epub 2020 Mar 26.


Objective: 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 sources: Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review.

Study selections: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Ambulatory Care
  • Anti-Bacterial Agents / adverse effects*
  • Antimicrobial Stewardship
  • Child
  • Critical Pathways
  • Delivery of Health Care
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / epidemiology*
  • Drug Utilization
  • Humans
  • Penicillins / adverse effects*
  • Practice Patterns, Physicians'
  • Prevalence
  • Risk Management
  • Skin Tests


  • Anti-Bacterial Agents
  • Penicillins