Success of amoxicillin challenges in the emergency department for children with low risk of serious reactions
Bibliographic record
Abstract
Objective: This study aimed to address the overdiagnosis of penicillin allergies in the pediatric population, which leads to less effective antibiotic usage. We investigated the effectiveness of standardized oral amoxicillin challenges in the emergency departments (EDs) of pediatric patients with previous reactions but a low risk for serious reactions. Methods: Children under 18 years of age who reported allergy to any penicillin presenting to the ED of the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Montreal, Quebec, Canada, with a clinical requirement for amoxicillin treatment were included if their risk of anaphylaxis was judged to be low. We evaluated immediate and delayed reactions, patient demographics, the impact on resource utilization, and the number of patients no longer considered to be allergic to penicillins at the 1-month follow-up. Results: From August 2021 through April 2023, 100 children received an oral amoxicillin challenge in the ED. Among them, 93% safely received amoxicillin without an immediate reaction and were discharged with amoxicillin from the ED. Seven participants had immediate reactions which included skin rashes or vomiting, with one participant experiencing an anaphylactic reaction. Five of the seven subsequently had an amoxicillin challenge by an allergist and only the one with anaphylaxis in the ED reacted. Suspected delayed reactions were observed in 4 of the other 89 (4%) participants who could be contacted within 30 days of the challenge and consisted of skin rashes. Three of the four subsequently had an amoxicillin challenge by an allergist and one reacted. Then, two patients (2%) had confirmed allergies following suspected reactions: one patient with the anaphylactic reaction, and the other with the delayed reaction. Overall, 79/89 (89%) of patients with 30-day follow-up could have their allergy label removed without an allergist consultation. Conclusions: Standardized oral amoxicillin challenges in low-risk pediatric ED patients allowed for the removal of penicillin allergy labels in 89% of patients reached for follow-up without an allergist consultation. This approach enhanced patient care, allowing 93% of participants to be discharged from the ED with an amoxicillin prescription. Only 2 of 100 children had proven amoxicillin allergy; another 3 had reactions but no assessment by an allergist.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".