Removing Low-Risk Penicillin Allergy Label Leads to Healthcare Cost Savings

Pills, capsules, tablets
Pills, capsules, tablets
Children deemed low risk who were tested for penicillin allergy tolerated the medication within the following year without serious adverse or allergic reactions.

Children with low-risk penicillin allergy symptoms and who tested negative for penicillin allergy tolerated a penicillin challenge without severe reactions and delabelling these cases would result in significant healthcare cost savings, according to research published in Pediatrics.

A follow up questionnaire was administered to parents or primary care providers of 100 children whose test results were negative for penicillin allergy during previous 3-tier penicillin allergy testing on children with low-risk symptoms. The survey responses and baseline patient characteristics were used to determine whether serious reactions would occur upon re-exposure to penicillin and changes in prescription patterns. A cost savings and avoidance analysis was performed.

A total of 46 prescriptions from 36 patients were reported and 26 of these (58%) were for penicillin derivatives. A rash developed in only 1 child 24 hours after starting the medication and there were no serious adverse reactions.

The cost savings analysis found that not labelling patients as penicillin allergic saved $1368.13, the cost avoidance equalled $1812.00, and the total potential savings for the pediatric emergency department was $199,223.00.

Investigators found that 10% of the parents involved in the follow up were unaware of their child’s negative result and the subsequent removal of the allergic label. A further 28% of parents were not comfortable or only somewhat comfortable giving their child penicillin after the negative tests.

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These findings highlighted the need for clear and succinct discharge paperwork and the power that labelling children allergic can have on parenting behavior. The results demonstrated the large potential cost savings for pediatric emergency departments and future multicenter trials should be performed. Investigators also noted that real time allergy delabelling in the emergency room would be a safe alternative to skin testing and would “lead to substantial cost savings in health care throughout the United States.” 


Vyles D, Chiu A, Routes J, et al. Antibiotic use after removal of penicillin allergy label. Pediatrics. 2018; 141(5): e20173466.