When children present to their family doctor or at the emergency room with a rash on the heels of antibiotic use, they are sometimes labelled as ‘penicillin allergic’. This label, once imposed, is kept for life. Studies estimate that 80% of those labelled as ‘penicillin allergic’ are actually not, yet they are exposed to broader spectrum antibiotics for their entire lives as a result of this diagnosis. A recent position statement from the Canadian Pediatric Society urged physicians to identify and delabel children inaccurately deemed ‘penicillin allergic’ early on, averting unnecessary and over use of broad spectrum antibiotics, and preserving subspecialist pediatric allergists’ time for difficult problems.
Dr. Jennifer Balfour wanted to bring this broader effort to delabel children to Victoria and initiated a project with pediatric allergy and immunology colleagues Dr. Scott Cameron and Dr. Victoria Cook. Together they sought to develop a pathway to rapidly delabel children with antibiotic allergy using a grant from the South Island Medical Staff Association’s Facility Engagement funding. Drawing together pediatricians, ER physicians, allergists, pharmacists, nursing staff and unit managers from Island Health, the group first identified the key issues to resolve, and designed an easily-accessible website for patients and practitioners outlining the process of rapid delabelling. They developed a protocol aligned with the new guidelines from the Canadian Pediatric Society on this topic and made it relevant to our local community. A brainstorming event outlined the background, clinical relevance, and potential impact, and explored barriers and solutions.
After a child is identified as likely not penicillin allergic, the next step sometimes requires an oral challenge under medical supervision. Ideally, this would take place in the newly constituted Urgent Pediatric Access Clinic (UPAC) at Victoria General Hospital. Though the group anticipated some challenges in ensuring uptake of the new protocol, they could not have planned for the emergence of COVID-19 at precisely the moment when oral challenges were set to begin. Many oral challenges can require the safety of medical supervision as well as the chance to clearly review the history and outcome of the challenge. As a result, the oral challenge portion of the project has been paused until it is deemed appropriate to restart.
Speaking about the value of the funding, Dr. Balfour noted that the project would not have moved forward without FE support. To bring together this number of practitioners from Allergy, ER, General Pediatrics as well as Pharmacy required funding to support people’s time. The grant “kept us moving forward and allowed commitment to really important work that would have otherwise been ‘side of our desk’”, she said. Next steps for this work include working with community primary care physicians to ensure children are being identified and referred appropriately for delabelling.
We commend the group for bringing this important project forward and wish them the best in the further rollout of their newly developed protocol in the coming months.