: Penicillin (PCN) allergy is frequently mislabeled and inaccurately diagnosed in children. Successful implementation of pediatric emergency department (PED) delabeling efforts requires parental understanding and willingness for children to be delabeled as PCN non-allergic.

To describe parental perspective on allergy delabeling in the PED for children identified as low risk for true penicillin (PCN) allergy.

Cross-sectional survey of parents of children with documented PCN allergy presenting to a single tertiary-care PED. Parents were first approached to complete a PCN allergy identification questionnaire to stratify their child as high- or low-risk for true PCN allergy. Facilitators and barriers to PED-based oral challenge and delabeling were subsequently assessed in parents of low-risk children.

A total of 198 participants completed the PCN identification questionnaire. Of 198 children, 49 (25%) screened low risk for true PCN allergy. Of the 49 low-risk children, 29 (59%) parents were uncomfortable with PED-based PCN oral challenge. Reasons included: fear of allergic reaction (72%), availability of adequate alternative antibiotics (45%), and longer PED stay (17%). Reasons for willingness to delabel included PCN's low side effect profile (65%) and avoidance of antimicrobial resistance from alternative antibiotics (74%). Participants without family history (FH) of PCN allergy were more comfortable with PED-based PCN oral challenge (60% vs. 11%; p = 0.001) and delabeling (67% vs. 37%; p = 0.04) compared to those with FH.

Most parents of low-risk PCN allergic children are uncomfortable with oral challenge or delabeling in the PED. Prior to implementing oral challenges in PEDs, efforts should be made to highlight the safety of oral challenging low-risk children, the benefits and risks of alternative antibiotics, and the minimal impact that FH has on PCN allergy.