Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Chelsie Derman

A study showed that high-income countries had a greater prevalence of 

“Notably, as has been described previously, we found very little data from outside high-income countries, and we only found a single study published from a [low-middle-income country] and none from [low-income country],” wrote investigators, led by Akish Luintel, PhD, from Imperial College London, St Mary's Hospital, in London.

For instance, Africa and most of Asia and South America had little data on penicillin allergy prevalence.

Patients labeled with penicillin allergy often receive broad-spectrum antibiotics, which are linked to antimicrobial resistance and poorer outcomes. However, approximately 95% of patients are likely mislabeled with this allergy.

Lately, de-labeling programs have been growing but only in selected countries. Even in the US, the incorrect allergy label persisted in electronic medical records or pharmacy records despite efforts of de-labeling programs, as seen in a 2019 study.

Investigators conducted a systematic review and meta-analysis to assess the global prevalence of penicillin allergy, intending to understand the potential impact of de-labeling programs.

 The team reviewed all studies on the prevalence of penicillin allergy among adults between January 2003 and June 2023, leveraging data on penicillin allergy prevalence, allergy recording methods, healthcare settings, and country income.

Out of the 18,353 studies screened, 174 studies from 28 countries were included. Most studies were from high-income countries (92%), with 72% from the US, UK, or Australia. More than 50% of studies were conducted in the US alone.

High-income countries included the US, Canada, UK, France, Netherlands, Spain, Portugal, Belgium, Denmark, Norway, Estonia, Finland, Italy, Latvia, Russia, Slovenia, Oceania, Australia, New Zealand, and Saudi Arabia. Upper-middle-income countries included Mexico, Turkey, China, and Colombia. The only included low-middle-income country was Pakistan.

The global prevalence of penicillin allergy was 9.4% (95% confidence interval [CI], 8.4 – 10.4%). High-income countries had a 9.9% prevalence of penicillin allergy (95% CI, 8.7 – 11.0%), which was significantly greater than the 4.4% penicillin allergy prevalence in middle-income countries (95% CI, 2.8 – 6.2%) (

Investigators wrote the low data on penicillin allergy prevalence in certain continents, such as Africa, Asia, and South America, may suggest penicillin allergy in these places has a lower burden and thus receives less research. One study conducted in Africa found the prevalence of penicillin allergy labels was 4.12%. Likewise, research conducted in Vellore, India observed an overall antibiotic allergy label of 3%, indicating a lower rate of reported penicillin allergy.

“These studies indicate potentially lower prevalence rates outside Western [high-income countries],” investigators wrote. However, with so few studies from these areas, expansion of data is critical, prior to drawing further conclusions.”

Countries where English is the primary language—US, UK, Australia, and Candia) had prevalence levels of ≥ 10%; no other countries reached this prevalence. Investigators speculated that reported penicillin allergy may stem from language, ethnicity, or cultural factors.

The study observed that the method of allergy recording significantly impacted the reported prevalence. For instance, penicillin allergy was reported more from specific allergy modules of the electronic health record systems or manual chart view/questionnaires than datasets using coding such as ICD-10. This indicates that coding may not be completed as comprehensively as a chart for reporting penicillin allergy.

Furthermore, few studies were conducted in primary care (6.5%; 95% CI, 0.2 – 20.5%) compared with secondary care (10.2%; 9.2% - 11.3%).

Investigators believed this could be because penicillin allergy is likely to be managed by secondary care physicians and many studies examined the effect of penicillin allergy on surgical outcomes, explaining why there was a lot of hospital data. Some countries also have less primary care than secondary care so patients are seen directly by specialists.

Still, primary care research is underrepresented in the literature. Investigators stressed the importance of removing or preventing incorrect labels in primary care.

“This shift in focus could potentially lead to more effective strategies for managing penicillin allergy and improving antibiotic stewardship practices,” investigators wrote. “More generally, work should be done in primary as well as secondary care even in [high-income countries], especially given the number of antibiotics prescribed here.”

Luintel, A, Healy, J, Blank, M. The Global Prevalence of Reported Penicillin Allergy: A Systematic Review and Meta-Analysis. Journal of Infection. Vol. 0, Issue 0, 106429. 2025.

Gingerich, C. Patient Fears, Records Reduce Penicillin Allergy De-labeling Efforts. HCPLive. February 24, 2019. 

https://www.hcplive.com/view/patient-fears-records-reduce-penicillin-allergy-delabeling-efforts

Articles

A systematic review and meta-analysis assessed the global prevalence of penicillin allergy, revealing higher rates in high-income countries compared to middle-income ones. The study highlighted a significant lack of data from low-income regions, suggesting a potential underestimation of penicillin allergy prevalence in these areas. The prevalence was notably higher in English-speaking countries, possibly due to cultural or linguistic factors. The study emphasized the importance of de-labeling programs and the need for more primary care research to improve antibiotic stewardship and manage penicillin allergy more effectively.

A study found penicillin allergy prevalence is higher in high-income countries (9.9%) than in middle-income ones (4.4%), highlighting disparities in reporting and research.


Penicillin Allergy Prevalence Greater in High-Income vs. Middle-Income Nations

Pediatric stimulant dispensing rates dropped nearly 19% at the onset of the COVID-19 pandemic, with subsequent Adderall shortages in 2022 prompting shifts toward alternative medications, a new study found.

“Our findings suggest that the Adderall shortage did not cause many children to stop stimulant therapy altogether, but it did force some to switch to alternative stimulants,” said lead investigator Sijia He, MS, from the Susan B. Meister Child Health Evaluation and Research Center in the University of Michigan.

The shortage of immediate-release mixed amphetamine salts, such as Adderall, began in October 2022.

 Until now, no national study has assessed changes in stimulant dispensing to children after the COVID-19 pandemic and the Adderall shortage.

Investigators sought to evaluate monthly changes in prescription stimulant dispensing to children aged 5 – 17 years during the start of the COVID-19 pandemic (March 2020) and the Adderall storage (October 2022). They leveraged 2017 to 2023 data from the IQVIA Longitudinal Prescription Database, capturing 92% of US prescriptions.

From January 2017 to March 2020, the monthly stimulant dispensing rate to children was reduced by 18% (-454.9 children per 100,000; 95% confidence interval [CI], -572.6 to -337.2). The rate increased after March 2020 to 12.7 children per 100,000 (95% CI, 6.6 to 18.8).

The nationwide shortage of immediate-release mixed amphetamine salts in October 2022 did not result in a significant level (-39.7 children per 100,000; 95% CI, -189.9 to 110.5) or slope change (-12.1 children per 100,000; 95% CI, -27.5 to 3.3). This indicated that the shortage did not necessarily prevent children from starting or stopping stimulant therapy.

However, in October 2022, there was a reduction in the monthly dispensing rate for immediate-release mixed amphetamine salts and an increase in the monthly dispensing rate for dexmethylphenidate. The study also observed a slope increase in the monthly dispensing rate of atomoxetine in October 2022.

This finding indicates that some children may have switched from immediate-release mixed amphetamine salts to other stimulants or nonstimulants.

“This would be potentially concerning if the switches may have resulted in worsened ADHD control. We need more research to evaluate whether any switches led to adverse outcomes,” He said.

Stimulant dispensing rates varied by sex.

 In December 2023, the dispensing rate for male adolescents was 19% lower than expected. For boys aged 5 to 11 years, the dispensing rate was similar to what was expected. Moreover, the stimulant dispensing rate was 9% greater than expected among girls aged 5 to 11 years, consistent with an earlier study that had shown that children with a first-time ADHD diagnosis during the pandemic were more likely to be girls.

In the press release, Kao-Ping Chua, MD, PhD, from the University of Michigan Health C.S. Mott Children's Hospital, said the findings could represent a decrease in the underdiagnosis and undertreatment of ADHD in girls.

“It’s also possible that symptoms of inattention in girls increased during the pandemic, increasing their need for stimulants,” Chua said.

During the pandemic, access to in-person health care was disrupted, reducing the opportunities to diagnose and treat ADHD. Chua believes the decrease in in-person healthcare could be because of a policy that allowed stimulants to be prescribed via telehealth.

Production issues and stimulants having an unprecedented demand led to the 2022 Adderall Shortage. Chua suggested policymakers consider raising limits on stimulant production and ensuring appropriate stimulant prescribing to adults.

“Our findings indirectly demonstrate how increased demand for a medication class in adults may adversely affect access to these treatments for children,” Chua said. “It’s crucial to address the shortage of stimulant medications because so many kids rely on them. Untreated ADHD symptoms can harm children’s health and learning.”

He S, Esteban McCabe S, Conti RM, Volerman A, Chua KP. Prescription Stimulant Dispensing to US Children: 2017-2023. Pediatrics. 2025 Jan 27:e2024068558. doi: 10.1542/peds.2024-068558. Epub ahead of print. PMID: 39864457.

Adderall shortage may be associated with increased use of alternative ADHD medication in children. January 27, 2025. 

https://www.eurekalert.org/news-releases/1071332

Pediatric stimulant dispensing rates decreased by nearly 19% at the onset of the COVID-19 pandemic, with a subsequent Adderall shortage in 2022 prompting shifts toward alternative medications. The shortage did not significantly impact the overall initiation or cessation of stimulant therapy, but it did lead to increased dispensing of alternative stimulants like dexmethylphenidate and atomoxetine. The study highlights potential concerns about ADHD control due to medication switches and suggests a possible decrease in underdiagnosis and undertreatment of ADHD in girls during the pandemic.

A new study found stimulant use in children dropped 19% early in the pandemic but rebounded, with the 2022 Adderall shortage prompting shifts to alternatives.

Pediatric Stimulant Use Drops Amid COVID-19 and Adderall Shortages

A recent study showed that food allergies have no negative effect on school performance.

“We also found some statistically significant interactions with parental education, but not sex, although with no consistent pattern,” wrote investigators, led by Cecilia Lundholm, PhD, from the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden.

Research has shown that food allergies can negatively impact children’s mental health, leading to more internalizing problems, such as anxiety and depression, than their peers. In the past decade, psychology referrals dramatically increased for children with food allergies.

 Studies have also suggested that internalizing disorders in children are associated with school performance, so investigators theorized that food allergies may impact school performance.

In their register-based cohort study, investigators sought to assess whether food allergies were linked to school performance. The sample included children in grades 7 – 9 (n = 456, 164) born in Sweden from 2001 – 2005 and had food allergy information based on hospital visits and prescriptions. Investigators collected data on grades and national test results from all Swedish schools to assess school performance.

The primary outcome was the total grades from children in year 9, and the secondary outcome was the total grades from younger children. On top of assessing children with food allergies, the study also included a sibling/twin control analysis (n = 31,609).

In adjusted and unadjusted analyses, children with severe food allergies appeared to have better total grades than children without food allergies (95% confidence interval [CI], 8.6 to 12.6). After adjusting for unmeasured confounders shared by siblings, the difference was close to null and nonsignificant (95% CI, -1.5 to 4.7; 95%; -2.2 to 2.1) for severe and non-severe food allergies, respectively.

Investigators found a significant association between food allergies and performance on the national English test in year 9 in sibling control analyses, though the effect was small. However, this was not replicated in the twin cohort.

These findings were similar to the results of trials on atopic diseases, atopic eczema, asthma, and rhinitis, indicating that children and adolescents with these diseases may perform as well or even better than their peers without those diseases.

“The difference between our results and those for severe eczema, asthma, and rhinitis may be explained by children with food allergy, successfully avoiding the allergens that causes reactions, do not need to take medication and may have as good somatic health as their peers without food allergy,” investigators wrote. “For the other atopic diseases, it may be more difficult to avoid the triggers of the disease and may therefore have worse somatic health or need medication that may have side effects.”

The team added that the results may be explained by the fact they accounted for familial factors that could affect a child’s health-seeking behavior and school performance.

Investigators wrote that the study’s primary limitation was the measurement of food allergy, as it relied on specialist care diagnoses and adrenaline autoinjector dispenses in the registers. This led to misclassification of undiagnosed primary care-diagnosed cases. Moreover, they added that the results could be limited by the inability to capture the temporary impacts of food allergy on school performance.

“Although significant associations were found in the cohort analyses adjusted for important measured confounders, indicating better school performance in children with food allergy compared to those without, the results did not hold when also accounting for unmeasured familial factors in the sibling control analyses,” investigators wrote.

Lundholm C, Karim H, Smew AI, Silverman M, Gong T, Brew BK, Almqvist C. Food allergy has no negative impact on children's school performance: A Swedish sibling and co-twin control study. J Allergy Clin Immunol Glob. 2024 Dec 4;4(1):100380. doi: 10.1016/j.jacig.2024.100380. PMID: 39844913; PMCID: PMC11750558.

Derman, C. Psychology Referrals Rose for Children with Food Allergies in the Past Decade. HCPLive. October 24, 2024. 

https://www.hcplive.com/view/psychology-referrals-rose-children-food-allergies-the-past-decade

A study from Karolinska Institutet examined the impact of food allergies on school performance in Swedish children. Despite previous research linking food allergies to mental health issues, the study found no significant negative effect on academic performance. Children with severe food allergies initially appeared to have better grades, but this difference was nullified after adjusting for familial factors. The study also noted a minor association with national English test performance, but this was not consistent across all analyses. Limitations included potential misclassification of food allergy diagnoses and inability to capture temporary impacts.

A study found no negative effect of food allergies on school performance, with better grades in severe cases, but results were nonsignificant in sibling analyses.

Food Allergies Have No Negative Effect on School Performance

Supernus Pharmaceuticals announced on January 27, 2025, that the 

 approved an update for the label for viloxazine extended-release capsules (Quelbree) to include new lactation data for breastfeeding with 

, stating the low likelihood of the medication transferring into breastmilk. The updated label also now describes the medication’s partial agonist activity at the serotonin 5-HT2C receptor and inhibition of the norepinephrine transporter.

“This label update and new data deepens our understanding of Qelbree, providing valuable insights to help support treatment decision-making for people living with ADHD,” said Stephen M. Stahl, MD, PhD, health sciences clinical professor of psychiatry and neuroscience at the University of California Riverside and adjunct professor of Psychiatry of University of California San Diego, in a statement. “The updated pharmacodynamic data, which highlights viloxazine’s effects on the serotonin 5-HT2C receptor and inhibition of the norepinephrine transporter, adds depth to our understanding of Qelbree’s multimodal pharmacodynamics.”

FDA approved viloxazine extended-release capsules

 as an ADHD treatment for children aged 6 – 17 years on April 2, 2021 and for adults aged ≥ 18 years on May 1, 2022.2,3 This medication may increase blood pressure and heart rate, cause manic episodes in patients with bipolar disorder, and lead to adverse events of sleepiness, not feeling hungry, tiredness, nausea, vomiting, trouble sleep, irritability, insomnia, headache, dry mouth, and constipation.

The updated label follows the FDA’s suggestion in 2019 to conduct lactation studies to inform breastfeeding with drug use recommendations. A study evaluated the secretion of 600 mg daily viloxazine and its metabolite (5-HVLX-gluc) into breast milk among 15 healthy lactating women.

The study found the estimated daily infant dose of viloxazine and 5-HVLX-gluc for a nominal infant body weight of 6 kg was 0.085 mg/kg and 0.00595 mg/kg, respectively. The relative infant dose was approximately 1% for viloxazine and 0.07% for 5-HVLX-gluc of the weight-normalized maternal daily dose of 8.58 mg/kg viloxazine. The results suggest that the transfer of viloxazine into breastmilk is low; however, the study did not specifically assess the effects of viloxazine on breastfed infants or milk production.

Supernus Pharmaceuticals recognized the need to consider the developmental and health benefits of breastfeeding, especially in terms of the mother’s need for viloxazine and any potential adverse events on the breastfed child.

“By expanding Qelbree’s label to include new data on the pharmacodynamics and use in breastfeeding mothers, Supernus continues to empower healthcare providers and patients to make informed treatment decisions,” said Jack A. Khattar, president and chief executive officer of Supernus Pharmaceuticals, in the press release. “We are committed to building the body of evidence surrounding Qelbree’s use within the ADHD space and providing an effective treatment option for those living with ADHD.”

Supernus Announces Label Update for Non-Stimulant ADHD Treatment, Qelbree®, Including New Pharmacodynamic Data and Information for Breastfeeding Women. Supernus Pharmaceuticals. January 27, 2025. 

https://ir.supernus.com/news-releases/news-release-details/supernus-announces-label-update-non-stimulant-adhd-treatment.

Supernus Announces FDA Approval of Qelbree™ (SPN-812) for the Treatment of ADHD. Supernus Pharmaceuticals. April 2, 2021. 

https://ir.supernus.com/news-releases/news-release-details/supernus-announces-fda-approval-qelbreetm-spn-812-treatment-adhd

Kunzmann, K. FDA Approves Viloxazine Capsules for Adults with ADHD. HCPLive. May 1, 2022. 

https://www.hcplive.com/view/fda-approves-viloxazine-capsules-adults-adhd

Supernus Pharmaceuticals has updated the label for viloxazine extended-release capsules (Quelbree) to include lactation data, indicating a low likelihood of the drug transferring into breastmilk. The label now also details the drug's partial agonist activity at the serotonin 5-HT2C receptor and norepinephrine transporter inhibition. This update follows an FDA recommendation to conduct lactation studies. The study found minimal drug transfer into breastmilk, but did not assess effects on infants. The update aims to support informed treatment decisions for ADHD patients, including breastfeeding mothers.

The FDA approved updated labeling for viloxazine ER capsules as an ADHD treatment, adding lactation data and details on serotonin 5-HT2C receptor activity.