Clinical Pathway for the Management of Children
with a Reported Penicillin (PCN) Drug Allergy
- Related Pathways
Child with a reported Penicillin (PCN) Allergy
Excluded: cephalosporin allergy
Excluded: cephalosporin allergy
Only 5%–10% of children with a PCN allergy label are truly allergic
- History and Physical
- Details, timing of reaction
- Signs and symptoms of possible PCN allergy
History of Severe Cutaneous
Adverse Reaction
Adverse Reaction
- Steven Johnson Syndrome (SJS)
- Toxic Epidermal Necrolysis (TEN)
- Drug Reaction w/Eosinophilia and Systemic Symptoms (DRESS)
Avoid PCN and cephalosporin
Low Risk for PCN Allergy
(benign delayed rash)
(benign delayed rash)
History of
All Other Reactions
All Other Reactions
- Family history only
- GI symptoms only
- Child tolerated drug since initial reaction
- Maculopapular rash onset ≥ 3 days into course
- No hives, pruritus or other symptoms
- Well-appearing
- Including, but not limited to:
- Anaphylaxis
- Wheezing, respiratory distress
- Angioedema
- Hives
- Rash < 3 days after first dose
- Erythema multiforme
- Serum sickness like reaction
Remove PCN Allergy label
- Remove PCN allergy label
- Give PCN antibiotic if indicated
- Refer to allergy if team or family has additional questions
- Allergy Clinic Referral
- Avoid PCN until referral
- Guidance for Prescribing Selected Cephalosporins for PCN-Allergic Children
- For inpatients requiring penicillin antibiotics, consult allergy
- Provide Family with PCN PFE
| Severe Cutaneous Reactions | |
|---|---|
| SJS/TEN |
|
| DRESS |
|
Evidence
- Drug allergy: A 2022 Practice Parameter Update
- Antibiotic Allergy in Pediatrics
- Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department
- Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms
- Antibiotic Use After Removal of Penicillin Allergy Label
- The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk
- Risk of Methicillin Resistant Staphylococcus Aureus and Clostridium Difficile in Patients with a Documented Penicillin Allergy: Population Based Matched Cohort Study
- A Multidisciplinary Quality Improvement Initiative to Facilitate Penicillin Allergy Delabeling Among Hospitalized Pediatric Patients
- Evaluation and Management of Penicillin Allergy: A Review
- Children with Reported Penicillin Allergy: Public Health Impact and Safety of Delabeling