Kennedy Sheds Unnecessary Allergy Label with ‘Quick and Easy’ Testing

The first time Kennedy broke out in a rash, her mom, Christine, felt more confused than concerned.

The red spots began popping up all over the 6-year-old’s body three days after she started taking the antibiotic Augmentin (a penicillin-based medicine) to treat an infection. “The rash was everywhere,” Christine said. “It was all over her back, her face, her arms. I thought it was chickenpox, but she’d had the vaccine for that.”

Christine called the pediatrician, who had her bring Kennedy into the office.

“They told us it could be a reaction to the antibiotic, but because her infection had cleared up, we could just stop the antibiotic altogether,” Christine said. “They put in her chart that she could be allergic to Augmentin so she shouldn’t have it prescribed in the future.”

Fast forward to about a year and a half later: Kennedy developed an ear infection and was prescribed the antibiotic Omnicef (a non-penicillin-based medicine) to treat it. A few days later, a rash showed up. This time, Kennedy and her family were at the park. “There were big welts all over her face,” Christine said.

The family rushed to see the pediatrician, who switched Kennedy to a third antibiotic—and referred her to Cincinnati Children’s Pediatric Antibiotic Allergy Testing Services (PATS).

Antibiotic Allergy Testing at Cincinnati Children’s

PATS offers simple and safe antibiotic testing for kids like Kennedy who developed a rash in the past after taking the medication. The goal of testing is to either confirm or rule out the association between the antibiotic and the allergic reaction while providing a safety net for kids and their parents.

Christine scheduled two different tests for Kennedy: one for Augmentin and one for Omnicef.

Ahead of the first appointment, Kennedy was a little nervous, Christine said. “She didn’t know what to expect, and I didn’t either.”

Right away, though, the team helped Kennedy feel at home.

“Everyone was so friendly,” Christine said. “It made it a lot easier for her.”

Within the first five minutes of the appointment, Kennedy received a dose of amoxicillin, the most commonly prescribed form of penicillin, and “we basically just hung out for an hour,” Christine said.

PATS Director Kimberly Risma, MD, PhD, and other team members stayed close so they could act quickly if Kennedy had a reaction. They also explained what would happen if she did.

“We spend time with patients and their parents talking about how rare the allergy is, but also letting them know that if there is a severe allergic reaction in the clinic, we are good at treating it. Although equally uncommon, an allergic reaction may also occur after they go home,” Dr. Risma said.

In that case, Dr. Risma explains, there’s a whole team available just a phone call away. They can coach the parents on what to do, recommend allergy medications to alleviate symptoms and, in rare cases, prescribe a steroid to reduce inflammation. They may also refer the child to the emergency department (ED) if the reaction merits immediate evaluation —and give the ED a heads-up that they’re on the way.

A Different Culprit

Kennedy didn’t have a reaction. She spent the hour coloring and chatting with staff members.

“She felt like a celebrity,” Christine said.

Plus, when Kennedy went home, she was officially cleared of her Augmentin allergy, and PATS let her pediatrician know. A few months later, Kennedy repeated the test, only this time with Omnicef. Once again, she didn’t have a reaction.

The testing proved that Kennedy is among the 98% of pediatric patients who don’t have the antibiotic allergy they were told they might. Instead of a reaction to the antibiotic, the rashes were likely a reaction to whatever infection Kennedy’s body was fighting.

When an antibiotic is listed in a child’s medical chart, it’s called an “allergy label,” explained Tricia Earl, RN, a PATS clinical care coordinator. Unless the suspected allergy is proven or disproven (and most go untested), pediatricians avoid prescribing the antibiotic. But that often takes away an entire class of drugs that could help them fight common childhood infections. 

Penicillin, for example, can treat many bacterial illnesses, like ear infections and strep throat. But it’s the most reported medication allergy. Azithromycin is another common antibiotic associated with suspected allergies, but it’s also one of pediatricians’ best treatments for pneumonia.

Eliminating Unnecessary (and Costly) Allergy Labels

Allergy labels also can be very expensive.

“When a child is sick and has an infection, the alternative can’t be to take nothing,” Earl said. “They need to be treated. But the options after the first choice to fight an infection often aren’t better. They’re typically more expensive and have more toxic profiles, meaning they can cause worse reactions than a rash.”

That’s why eliminating unnecessary allergy labels is so important. To make this more convenient for families, antibiotic allergy testing services are offered not only at the Cincinnati Children’s Burnet and Liberty campuses but also at neighborhood clinics and even via mobile care units in some areas.

Also, if the only symptom a child had after taking an antibiotic was a rash—meaning no swelling, vomiting or blistering—they may qualify for at-home testing through telehealth.

Finally, PATS offers same-day or next-day consultations for kids with acute reactions to antibiotics. That means kids who are currently experiencing a reaction while taking an antibiotic. Through PATS’ acute care allergy service, these kids can see a provider in person or via telehealth.

“Our acute care allergy service is really unique,” Dr. Risma said. “I’m not aware of any other allergy division across the country that offers it. We started it because we noticed kids were going to the ED and paying high co-pays when it may not be necessary. Now, they don’t have to.”

“Quick and Easy” Test Yields Great Results

Despite the benefits of antibiotic allergy testing, Dr. Risma said she understands why kids are initially nervous when they come in to see her or another provider.

“I’ve never met them before and within five minutes of them coming in, I’m squirting medicine in their mouth,” she said. “It takes a lot of trust.”

Yet for Kennedy, the most important takeaway was “there were no shots, needles or bloodwork,” Christine said. “It was just oral medication and watch-and-wait for an hour. She’s now cleared of both allergies, and it was very quick and easy.”

(Published December 2024)