Antibiotic allergy labels in children are associated with adverse clinical outcomes

Publication date: Available online 19 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Michaela Lucas, Annabelle Arnold, Aine Sommerfield, Michelle Trevenen, Laure Braconnier, Alina Schilling, Fuad Abass, Lliana Slevin, Brittany Knezevic, Christopher Blyth, PhD. Kevin Murray, Britta von Ungern-Sternberg, Kristina Rueter

Abstract

Background

Self-reported antibiotic allergies are common among hospitalised adults and children. There is a paucity of studies investigating the impact of an antibiotic allergy label in childhood.

Objective

To investigate the impact of antibiotic allergy labelling on clinical outcomes in children.

Method

Retrospective study conducted in a major paediatric tertiary hospital, to capture 1672 inpatient admissions in April 2014 and April 2015. Data, collected by chart review, included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.

Results

Of the 1672 paediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; the majority were beta-lactam labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P<0.001); no gender effect was seen. Patients with antibiotic allergy labels received more macrolide (p=0.045), quinolones (P=0.01), lincosamide antibiotics (P<0.001) as well as metronidazole (p=0.009) than patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis and admitting specialty, children with any antibiotic or beta-lactam allergy label had longer hospital lengths of stay (OR 1.62, 95% CI 1.05-2.50, P=0.03; with mean length of stay of 3.8 days for those without a label and 5.2 days for those with a beta-lactam allergy label).

Conclusions

This is the first study demonstrating the negative impact of antibiotic allergy labels on clinical outcomes in children, as evidenced by significant alternate antibiotic use and longer hospital lengths of stay.