Beta-lactam allergy is reported in 5–10% of children in North America, but up to 94–97% of patients are deemed not allergic after allergist assessment. The utility of standardized skin testing for penicillin allergy in the pediatric population has been recently questioned. Oral drug challenges when appropriate, are preferred over skin testing, and can definitively rule out immediate, IgE-mediated drug allergy. To our knowledge, this is the only pediatric study to assess the reliability of a penicillin allergy stratification tool using a paper and electronic clinical algorithm. By using an electronic algorithm, we identified 61 patients (of 95 deemed not allergic by gold standard allergist decision) as low risk for penicillin allergy, with no false negatives and without the need for allergist assessment or skin testing. In this study, we demonstrate that an electronic algorithm can be used by various pediatric clinicians when evaluating possible penicillin allergy to reliably identify low risk patients. We identified the electronic algorithm was superior to the paper version, capturing an even higher percentage of low risk patients than the paper version. By developing an electronic algorithm to accurately assess penicillin allergy risk based on appropriate history, without the need for diagnostic testing or allergist assessment, we can empower non-allergist health care professionals to safely de-label low risk pediatric patients and assist in alleviating subspecialty wait times for penicillin allergy assessment.

中文翻译：

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第一种将青霉素过敏风险分层的儿科电子算法

据报道，在北美洲，有5-10％的儿童对β-内酰胺过敏，但经过敏性评估后，多达94-97％的患者被视为对过敏。最近有人质疑标准化皮肤测试对小儿青霉素过敏的效用。适当时，口服药物挑战优于皮肤测试，并且可以最终排除IgE介导的药物过敏。据我们所知，这是唯一使用纸质和电子临床算法评估青霉素过敏分层工具可靠性的儿科研究。通过使用电子算法，我们确定了61名患者（其中95名被金标准过敏者决定认为没有过敏）为青霉素过敏的低风险，没有假阴性，并且不需要过敏评估或皮肤测试。在这个研究中，我们证明了各种儿科临床医生在评估可能的青霉素过敏以可靠地识别低危患者时可以使用电子算法。我们确定了电子算法优于纸质版本，与纸质版本相比，捕获的低风险患者比例更高。通过开发电子算法以根据适当的病史准确评估青霉素过敏风险，而无需进行诊断测试或过敏症评估，我们可以使非过敏症医疗保健专业人员安全地为低风险的儿科患者加上标签，并协助减轻亚专科病候次进行青霉素过敏评估。我们确定了电子算法优于纸质版本，与纸质版本相比，捕获的低风险患者比例更高。通过开发电子算法以根据适当的病史准确评估青霉素过敏风险，而无需进行诊断测试或过敏症评估，我们可以使非过敏症医疗保健专业人员安全地为低风险的儿科患者加上标签，并协助减轻亚专科病候次进行青霉素过敏评估。我们确定了电子算法优于纸质版本，与纸质版本相比，捕获的低风险患者比例更高。通过开发电子算法以根据适当的病史准确评估青霉素过敏风险，而无需进行诊断测试或过敏症评估，我们可以使非过敏症医疗保健专业人员安全地为低风险的儿科患者加上标签，并协助减轻亚专科病候次进行青霉素过敏评估。