Association of Sociodemographic Factors with Reported Penicillin Allergy in Pediatric Inpatients

Background: Penicillin allergy, reported in about 10% of patients in the United States, is the most common drug allergy. Data regarding sociodemographics of reported pediatric penicillin allergy is scarce, and we seek to further characterize this population in the pediatric inpatient setting.

Objective: To assess the sociodemographic factors in pediatric inpatients with reported penicillin allergy compared to all general pediatric inpatients

Methods: We conducted a retrospective cohort study of pediatric patients aged 0-18 years admitted to Duke Children’s Hospital general pediatric units January 1, 2019 to December 31, 2019. Penicillin allergy was defined as a documented allergy to penicillin, amoxicillin, amoxicillin-clavulanate, ampicillin, and ampicillin-sulbactam. Sociodemographic factors included gender, age, race, ethnicity, language, and insurance payer. We used Chi square tests of association to compare distribution of demographic variables between patients with and without a penicillin allergy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: We identified a total of 3,890 patients and of those patients, 299 (7.7%) had a reported penicillin allergy. As seen in Table 1, odds of penicillin allergy were significantly higher in patients of Caucasian/white race (OR 1.65, 95%CI 1.05-2.61), non-Hispanic/Latino ethnicity (OR 1.55, 95%CI 1.01-2.37), and patients with private insurance (OR 1.35, 95%CI 1.04-1.74). Odds of penicillin allergy were lower in patients whose preferred language was not English (OR 0.55, 95%CI 0.33-0.94). The data demonstrate an increasing odd of having a penicillin allergy with increasing age with 16-18y being 5.9 times more likely to have a penicillin allergy compared to < 1 year old patients (OR 5.92, 95%CI 3.40-10.31). No significant difference was found in identified gender between the two groups.

Conclusion: In this study, we characterize the sociodemographic factors of pediatric inpatients with reported penicillin allergy. Our data demonstrate significantly increased odds of penicillin allergy in patients of Caucasian/White race, non-Hispanic/Latino ethnicity, with private insurance, and increasing age while patients preferring a language other than English had lower odds of penicillin allergy. Interestingly, gender was not associated with increased odds of allergy. This data may suggest disparities, and future efforts will be focused on ensuring equity in drug allergy reporting, completeness of penicillin allergy labeling, and risk stratification of reactions to guide de-labeling initiatives.