Antibiotic allergy labels in children are associated with adverse clinical outcomes

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

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood. Objective: To investigate the impact of antibiotic allergy labeling on clinical outcomes in children. Methods: A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) 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 pediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; most were β-lactam allergy labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P <.001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P =.045), quinolones (P =.01), lincosamide (P <.001), and metronidazole (P =.009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95% CI, 1.05-2.50; P =.03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-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 stays. © 2018

Original languageEnglish
Pages (from-to)975-982
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume7
Issue number3
Early online date2018
DOIs
Publication statusPublished - 1 Mar 2019

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Hypersensitivity
Anti-Bacterial Agents
Length of Stay
Lactams
Lincosamides
Patient Readmission
Pediatric Hospitals
Hospitalized Child
Quinolones
Macrolides
Metronidazole
Tertiary Care Centers
Penicillins
Prescriptions
Inpatients
Retrospective Studies
Odds Ratio
Pediatrics

Cite this

Lucas, Michaela ; Arnold, Annabelle ; Sommerfield, Aine ; Trevenen, Michelle ; Braconnier, Laure ; Schilling, Alina ; Abass, Fuad ; Slevin, Lliana ; Knezevic, Brittany ; Blyth, Christopher ; Murray, Kevin ; von Ungern-Sternberg, Britta ; Rueter, Kristina. / Antibiotic allergy labels in children are associated with adverse clinical outcomes. In: Journal of Allergy and Clinical Immunology: In Practice. 2019 ; Vol. 7, No. 3. pp. 975-982.
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title = "Antibiotic allergy labels in children are associated with adverse clinical outcomes",
abstract = "Background: Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood. Objective: To investigate the impact of antibiotic allergy labeling on clinical outcomes in children. Methods: A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) 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 pediatric patients surveyed, 58.1{\%} were male and 44.8{\%} were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3{\%} of patients; most were β-lactam allergy labels (85{\%}), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P <.001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P =.045), quinolones (P =.01), lincosamide (P <.001), and metronidazole (P =.009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95{\%} CI, 1.05-2.50; P =.03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-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 stays. {\circledC} 2018",
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Antibiotic allergy labels in children are associated with adverse clinical outcomes. / Lucas, Michaela; Arnold, Annabelle; Sommerfield, Aine; Trevenen, Michelle; Braconnier, Laure; Schilling, Alina; Abass, Fuad; Slevin, Lliana; Knezevic, Brittany; Blyth, Christopher; Murray, Kevin; von Ungern-Sternberg, Britta; Rueter, Kristina.

In: Journal of Allergy and Clinical Immunology: In Practice, Vol. 7, No. 3, 01.03.2019, p. 975-982.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antibiotic allergy labels in children are associated with adverse clinical outcomes

AU - Lucas, Michaela

AU - Arnold, Annabelle

AU - Sommerfield, Aine

AU - Trevenen, Michelle

AU - Braconnier, Laure

AU - Schilling, Alina

AU - Abass, Fuad

AU - Slevin, Lliana

AU - Knezevic, Brittany

AU - Blyth, Christopher

AU - Murray, Kevin

AU - von Ungern-Sternberg, Britta

AU - Rueter, Kristina

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood. Objective: To investigate the impact of antibiotic allergy labeling on clinical outcomes in children. Methods: A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) 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 pediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; most were β-lactam allergy labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P <.001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P =.045), quinolones (P =.01), lincosamide (P <.001), and metronidazole (P =.009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95% CI, 1.05-2.50; P =.03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-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 stays. © 2018

AB - Background: Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood. Objective: To investigate the impact of antibiotic allergy labeling on clinical outcomes in children. Methods: A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) 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 pediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; most were β-lactam allergy labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P <.001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P =.045), quinolones (P =.01), lincosamide (P <.001), and metronidazole (P =.009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95% CI, 1.05-2.50; P =.03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-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 stays. © 2018

KW - Adverse reactions/hypersensitivity

KW - Antibiotic allergy labels

KW - Antimicrobial prescribing

KW - Pediatric drug allergy

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U2 - 10.1016/j.jaip.2018.09.003

DO - 10.1016/j.jaip.2018.09.003

M3 - Article

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JO - Journal of Allergy and Clinical Immunology: In Practice

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