Penicillin and penicillin-derivative allergy labels, including amoxicillin allergy, are common in pediatric practice and can prompt use of broader-spectrum antibiotics. The authors aimed to determine the proportion of children labelled as allergic to amoxicillin who were truly allergic and to assess whether a direct oral amoxicillin challenge, without prior skin testing, is a safe and effective method to remove incorrect allergy labels in low-risk pediatric patients in Northwestern Ontario.
The study focused on patients referred to pediatric allergy services at two hospitals in Northwestern Ontario between 2015 and 2025.
This investigation was a retrospective review of pediatric patients aged 6 months to 15 years who were referred for suspected amoxicillin allergy. Eligible patients underwent an oral amoxicillin challenge; detailed procedural steps, dosing schedules, or observation times were not reported in the abstract. Clinical data were extracted and summarized descriptively from electronic medical records (EMR).
Key inclusion criteria reported were age range (6 months to 15 years) and referral for suspected amoxicillin allergy. The study specified selection of low-risk patients for direct oral challenge, consistent with contemporary delabelling approaches that reserve skin testing for higher-risk presentations, although exact risk-stratification criteria used in this cohort were not detailed in the abstract.
Ninety-six pediatric patients met criteria and underwent direct oral amoxicillin challenge. Of these, 93 children, representing 96.9% of the cohort, tolerated the challenge without adverse events.
Three patients (3.1%) developed mild, delayed rashes following the oral challenge. The abstract describes these as mild and delayed; no immediate anaphylactic reactions or severe hypersensitivity events were reported. Additional metrics such as timing of rash onset after challenge, management of reactions, or any need for medical intervention were not specified in the source abstract.
All three patients who developed delayed rashes had previously reported delayed reactions after their initial amoxicillin exposure, with prior reaction timing described as 5–10 days post-exposure. For two of these patients, the delayed rashes observed after challenge were consistent with previously documented maculopapular reactions based on the EMR entries and caregiver-reported descriptions. The source does not provide further immunologic testing results or long-term follow-up for these patients.
In this retrospective cohort from Northwestern Ontario pediatric allergy clinics, the prevalence of true amoxicillin allergy among low-risk children carrying a reported penicillin allergy label was 3.1%. The authors conclude that a direct oral amoxicillin challenge without preceding skin testing was a safe and effective strategy to remove incorrect allergy labels in low-risk pediatric patients within this sample.
The report suggests that broader implementation of direct oral challenge for low-risk children could support antibiotic stewardship by allowing appropriate use of narrow-spectrum beta-lactams, potentially reducing reliance on alternative agents, lowering healthcare-related costs, and improving patient care. The abstract does not quantify potential cost savings, changes in prescribing patterns, or wider system-level impacts; such outcomes were not reported in the source material.
The study received approval from the Thunder Bay Regional Health Sciences Centre Research Ethics Board (IRB registration #00004396). Because the work was retrospective, the requirement for written informed consent was waived by the ethics committee. The authors declared no competing interests.
Limitations evident from the abstract include the retrospective design and limited detail provided about challenge protocols, criteria for low-risk classification, and management of the delayed rashes. The abstract does not report longer-term follow-up, specific demographic breakdowns, or other clinical variables beyond those summarized.
Among 96 low-risk pediatric patients (6 months–15 years) challenged with oral amoxicillin in Northwestern Ontario between 2015 and 2025, 96.9% tolerated the challenge and 3.1% developed mild delayed rashes consistent with prior reported delayed reactions. The authors report that direct oral challenge without preceding skin testing was safe and effective for delabelling low-risk children in this cohort and recommend consideration of broader implementation to support antibiotic stewardship and improved patient care. Details on exact challenge procedures, risk stratification criteria, and further clinical outcomes were not provided in the source abstract.