Algorithm to identify patients at low risk for penicillin allergy
It is very likely this patient IS NOT allergic to penicillin. They should receive a single dose drug challenge to this medication.
INFORMED CONSENT:
95% of patients with this history that are challenged to amoxicillin tolerate it with no allergic symptoms.
1% have hives only
4% have a delayed (non dangerous) rash develop
Equipment in your community clinic you will need to manage this:
Epineprhine 0.01mg/kg, with a 25 gauge, 1 1/2 inch needle for administration into the lateral thigh if required
or
Epineprhine autoinjector (EpiPen) 0.15mg and 0.3mg
Contraindications:
Currently on antihistamines (they will mask symptoms)
Vomiting more than once in the last 24 hours
Concerning respiratory symptoms (wheeze, needing O2)
Critically ill
Current Rash
NPO
Protocol:
Amoxicillin 15mg/kg orally (max dose for challenge of 250mg). Use oral chewable amoxicillin of 125mg/tablet or 250mg/tablet to reduce cost to family/clinic. You can round up to dosing as high as 30mg/kg to facilitate use of a chewable tablet. Tablet may be crushed, and mixed in water to improve taste if the child is picky). Parenteral administration should be avoided for this test dose.
Observe for 30-60 minutes. Was the dose well tolerated?