Multisite primary care led amoxicillin challenge pathway to safely remove penicillin allergy label

Introduction: Inappropriate penicillin allergy labels are often acquired early in life and persist into adulthood. This leads to poorer healthcare outcomes with increased expenditures overtime. Given these adverse effects on our healthcare system, efforts to safely remove inappropriate penicillin allergy labels are being implemented worldwide. Yet these methods often depend on direct subspecialty care, limiting widespread application. Objectives: Our study investigates whether a primary care led amoxicillin challenge (PLAC) can be safely and effectively implemented in a multisite pediatric clinic setting without additional allergy specific training or specialty care oversight. A secondary objective was to investigate our PLAC screening tool to safely remove penicillin allergy labels in the pediatric population. Methods: This is an observational prospective multisite study with a retrospective chart review of 39,414 patients, ages 4 months to 18 years, screened to identify those with a low-risk penicillin allergy at two outpatient pediatric clinics from January 2021 to July 2023. Via PLAC screening questionnaire, low-risk pediatric patients were categorized as PLAC candidates by a pediatric provider. Patients were grouped for a 1-h PLAC appointment 1–2 times per month. PLAC appointment involved administering a single dose of amoxicillin 45 mg/kg (250 mg max) followed by a 1-h observation by a general trained medical technician without advance anaphylactic training. Results: A total of 141 (11.1%) out of 1269 (3.2% of the screened population) pediatric patients with a penicillin label met criteria for PLAC, of whom 89 (63.1%) completed the PLAC. All 89 (100%) tolerated it uneventfully, leading to delabeling. Nonspecific rash was the most common historic reaction leading to penicillin allergy diagnosis for those 141 PLAC patients identified. Twenty-five months was the average age of penicillin allergy labeling, and the average time from historical reaction to delabeling was 63 months. Conclusions: Our study demonstrates a pediatric specific screener and pathway for pediatric providers to safely remove penicillin allergy labels following latest allergy practice parameters.