Deficiencies in the Assessment of Penicillin Allergy in Hospitalized Children in Hawaiʻi, 2021-2023

Although claims of penicillin allergy are common, after evaluation they are seldom confirmed and can lead to unnecessary interventions. National recommendations are to thoroughly evaluate potential allergies and, if appropriate, to delabel. This retrospective study reviewed records of children hospitalized at Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i, between January 1, 2021 and June 30, 2023 to assess the frequency of penicillin allergy claims, the appropriateness of their evaluation, and initiation of interventions. Of 3484 hospitalized children, 97 (2.8%) reported penicillin allergy. Documentation, by the admitting team, of the nature of allergy was incomplete for most (97%) of the hospitalizations, leading to deficient risk stratification, lack of implementation of recommended interventions, and frequent use of second-line antibiotics in 46.8% of those who required antibiotic treatment. While this problem is not unique to Hawai'i, it emphasizes the need for education among local providers to improve outcomes.