Background: Unsubstantiated antibiotic allergy labels affect between 8-25% of the population worldwide. Current risk stratification tools, derived from adult data, are not validated for children. A simplified, multi-patient protocol with minimal exclusion criteria is required to tackle the scale of this public health issue. Methods: Patients with possible antibiotic allergy were recruited from the Children’s Health Ireland (CHI) allergy waiting list. Exclusion criteria were a serum sickness like reaction (SSLR), severe cutaneous adverse reaction (SCARs), anaphylaxis, or non-allergic symptoms. No prior allergy testing was performed. Dosing was direct single observed dosing in dedicated mass delabelling clinics, followed by a two-day antibiotic course at home. Results: Consenting patients (n=162) were seen over 6 clinics with gradually increasing clinic sizes, (Range 18 to 62, average 23). One patient only was excluded based on the severity of their index event. Average age was 7 years, n=90/162 (55.6%) were female. Most were avoiding amoxicillin, n=137/162 (84.6%). Pass rates were in line with international outcomes, n=150/162 (92.6%), 3 had immediate reactions and 9 delayed. Patients retrospectively underwent risk stratification according to the 2024 EAACI position paper, high risk n=38/162 (23.5%), intermediate risk n=74/162 (45.7%) and low risk n=50/162 (30.9%). Those deemed high risk were no more likely to fail than those deemed low/intermediate risk (n=2/38, 5.3% vs n=10/124, 8.1%, p=0.56). Conclusion: Antibiotic allergy delabelling in paediatrics is low risk and can be done safely in high case volume without prior allergy testing. Current risk stratification tools for delabelling are not suitable for paediatric specific models of care.
