Available online 21 March 2023

Penicillin (PCN) allergy label, reported in approximately 5% of children, influences antibiotic choice and prolongs hospital stay. To our knowledge, the impact of PCN allergy label on clinical outcomes of pneumonia in children is not well-characterized.

To investigate the impact of PCN allergy label on clinical outcomes of pneumonia in children.

In this propensity score-matched cohort study, we used the TriNetX Research Network, a population-based database, to compare the 30-day risk of hospitalization, need for intensive level of care, and acute respiratory failure from pneumonia between pediatric patients (age 1-17 years) with and without a PCN allergy label after matching the two cohorts for demographic and medical co-morbidities. Antibiotic prescription patterns were also contrasted.

When comparing 3,793 pediatric patients with pneumonia labeled with a PCN allergy to matched children without a PCN allergy label, PCN allergy label was associated with a higher risk of hospitalization (RR, 1.15; 95% CI, 1.07 to 1.23), acute respiratory failure (RR, 1.27; 95% CI, 1.17 to 1.39), and need for intensive level of care (RR, 1.46; 95% CI, 1.15 to 1.84). PCN allergy label resulted in overutilization of broader-spectrum antibiotics and increased complications including cutaneous drug reactions (RR, 2.43; 95% CI, 1.31 to 4.52), and Clostridioides difficile infection (RR, 2.25; 95% CI, 1.14 to 4.44).

Children with a PCN allergy label are more likely to be hospitalized, receive broader-spectrum antibiotics, and develop acute respiratory failure from pneumonia. De-labeling may offer a way to lessen morbidity from pneumonia in children.

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology