Pedemy All toolsDescribe the reaction and get the next step: remove the label, do an amoxicillin challenge, or refer, with safe antibiotics meanwhile.
This tool helps a clinician decide what to do with a penicillin allergy label in a child. The first question asks what actually happened; one more question narrows the timing or severity, and the tool then shows whether to remove the label, do a direct oral amoxicillin challenge, or refer to an allergist.
Low-risk histories, such as a flat or hivey rash alone or a vague label from infancy, go straight to a supervised single dose of amoxicillin with 60 minutes of observation, as the 2022 drug allergy practice parameter suggests for children. Family history and simple side effects are not allergy, and the label can be removed without testing. Immediate reactions and anaphylaxis go to an allergist, while severe delayed reactions such as Stevens-Johnson syndrome or DRESS mean avoiding all beta-lactams.
Every result lists safe antibiotic choices while the label is in place, including cephalosporins with a different side chain from amoxicillin, which can be given even after penicillin anaphylaxis. Results also cover how to document a removed label and what to tell families. Challenge doses vary between protocols; follow a local protocol where one exists.
No. The 2022 drug allergy practice parameter suggests a direct oral amoxicillin challenge without skin testing for children with a benign skin rash, such as a maculopapular rash or hives without other symptoms.
Yes. A cephalosporin with a different side chain, such as cefdinir, cefpodoxime, cefuroxime or ceftriaxone, can be given without testing. Avoid cephalexin, cefadroxil, cefaclor and cefprozil, which share side chains with amoxicillin or ampicillin.
Give one treatment dose of amoxicillin (about 25 mg/kg, max 500 mg, or per local protocol) in clinic with anaphylaxis treatment ready, and observe for 60 minutes. Some protocols give 10% first, then the rest. If there is no reaction, remove the label.
No. Family history alone is not a reason to label a child, and the label can be removed without testing.
After a severe delayed reaction such as Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS, or a reaction with organ involvement. These children need an allergist, not a challenge in clinic.
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