Amoxicillin Allergy Trials

H/O amoxicillin allergy is rarely a true allergy. Get more information about what the reaction was, at what age it occurred, look at telemed pictures if you can, consult a pediatrician if they are little and consider amoxicillin challenge in the village OR bring them to ER or clinic in Bethel for this. Over 90% of the time there was not a true allergy and the flag was put on EMR because a parent reported a h/o rash or hives that was not really hives OR it was imported from our old medical record system and was not validated.

Example Auto text for RMT For Amoxicillin Trial

Autotext: ..rmtamox

ASSESSMENT:

• Patient’s history and medical records were reviewed and the patient does not have any evidence of a true allergy to amoxicillin.
• CHA and family are OK with trial of Amoxicillin

PLAN:

• Recommend Amoxicillin trial in clinic today.
• Document vitals, physical exam and good lung exam
• Have epinephrine available.
• Mix Amoxicillin
• Draw up a CHAM, weight based dose of Amoxicillin.
• Give the patient 1/10th of the dose in the clinic.
• Have patient remain at the clinic for 20 minutes for observation. Caretaker is to alert the CHAs of any concerns.
• After 20 minutes, if there are no problems, the patient may be given the rest of the dose of Amoxicillin.
• Have patient remain at the clinic for another hour for observation in waiting room..
• If there are no problems tolerating the test doses, then the patient may go home and continue medicine as prescribed.
• If a rash or any concerns come up, the patient should be brought back to clinic and a telemed picture and RMT should be sent in for the provider to review and get a pediatric consult if required.
• Give Amoxicillin Rash Handout to family to take home. Rash with amoxicillin is common in infants and young children and it is usually OK to continue the medicine unless the patient develops true hives, face swelling or difficulty breathing.

Resources/References

• Vyles D et al. Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department. Academic Pediatrics. 2017. doi.org/10.1016/j.acap.2016.11.004
• Vyles D, et al. Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms. Pediatrics. August 2017, 140(2)e20170471; doi.org/10.1542/peds.2017-0471
• Salkind, A. et al. Is This Patient allergic to Penicillin? An Evidence-Based Analysis ofthe Likelihood of Penicillin Allergy. JAMA, May 16, 2001--Vol 284, No. 19.
• Mill, C. et al. Assessing the Diagnostic Properties of a Graded Oral Provocation Challenge for the Diagnosis of Immediate and Nonimmediate Reactions to Amoxicillin in Children. JAMA Pediatr. 2016;170(6):e160033. doi:10.1001/jamapediatrics.2016.0033
• Khan, D. et al. Drug allergy. J Allergy Clin Immunol 2010;125:S126-37.
• Solensky, R. et al. Drug Allergy: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259-273. doi: 10.1016/j.anai.2010.08.002
• Stamping Out Amoxicillin Allergies 2019 (PowerPoint Presentation)
• Stamping Out Amoxicillin Allergy 2013 (PowerPoint Presentation)
• Amoxicillin Allergy Trials YKHC Clinical Guideline

YKHC Clinical Guidelines
Common/Unique Medical Diagnoses