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TOPLINE:
Direct amoxicillin challenges were tolerated by 96.8% of infants and toddlers with suspected penicillin allergy, according to a retrospective study. Those who reacted during the challenge typically developed mild cutaneous eruptions that were treated with antihistamines.
METHODOLOGY:
- Researchers conducted a retrospective chart review involving 250 infants and toddlers (mean age, 34.3 months; 46% girls) who underwent amoxicillin challenges in outpatient allergy clinics to evaluate a possible penicillin allergy.
- Participants were observed after a small initial dose of amoxicillin or amoxicillin-clavulanic acid, followed by a full therapeutic dose.
TAKEAWAY:
- Overall, 96.8% of participants tolerated the amoxicillin challenge.
- The 3.2% who developed symptoms during the challenge had mild skin reactions that were treated with oral antihistamines; no participant required epinephrine.
- Infants and toddlers had similar reaction rates.
IN PRACTICE:
“Offering early evaluation for PALs [penicillin allergy labels] can mitigate negative individual and public health outcomes associated with unnecessary lifelong penicillin avoidance, particularly in the toddler years where bacterial infections requiring antibiotic treatment are frequent,” the authors wrote.
SOURCE:
Timothy G. Chow, MD, with the University of Texas Southwestern Medical Center in Dallas, was the corresponding author of the study, which was published online on October 23, 2025, in The Journal of Pediatrics.
LIMITATIONS:
Only children with low-risk reaction histories whose parents consented were offered the challenge.
DISCLOSURES:
Chow has received grant support from the National Institutes of Health and personal fees from Sarepta Therapeutics, outside the study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
