D1.254 - Assessing the Accuracy of Penicillin Allergy Labels in Paediatric Care: Focusing on Educational Gaps in Both Families and Healthcare Workers

Penicillin allergy labels (PALs) affect up to 10% of the population. Inaccurate PALs limit treatment options and reduce patient outcomes.We evaluated PALs in paediatric patients at Evelina London Children’s Hospital to identify inaccuracies, documentation, and the barriers and opportunities for de-labelling. 

Between 28/10/2024 and 08/12/2024, children attending our ED or admitted to hospital with PALs were identified from health records, and patients/caregivers interviewed. Data were analysed for accuracy, and risk stratification applied using British Society for Allergy and Clinical Immunology (BSACI) recommendations.

Out of 7050 children reviewed, a total of 194 with PALs were identified, with 51 families were interviewed. PAL prevalence was 5.6%. 24 (47%) were female, median age was 10.8 years and 44 (86%) of patients had comorbidities.

Of 51 patients interviewed, 20 (39%) were identified as low-risk with reference to BSACI guidelines and could have been de-labelled by non-allergists. Only 45% of these were correctly identified as low-risk in electronic medical records, and 40% lacked documented risk levels. 

Interviews revealed that both parents and healthcare providers faced challenges in de-labelling. Concerns included fear of future reactions (n=3), lack of education about the risks of inaccurate labels, and systemic barriers to de-labelling. Five children were labelled as penicillin allergic despite tolerating penicillin after their initial reaction. Three children had never been prescribed penicillin due to family history of penicillin allergy. Families perceived healthcare providers as reluctant to de-label, citing delays and lack of referrals to allergy services from primary care. Only 2 (4%) of children had been referred to de-labelling services by their GP. 

This study highlights significant gaps in PAL documentation, clinician education, and parental understanding of PALs and de-labelling. Improved training for healthcare providers, particularly non-allergists, is essential for accurate risk categorization and effective de-labelling. Furthermore, addressing misconceptions and fears among families through clear educational materials and discussions on the de-labelling process could help reduce unnecessary antibiotic use, promote better antimicrobial stewardship, and enhance patient outcomes.