Explaining a false penicillin-allergy label and the delabelling pathway — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the clinic. A 6-year-old girl has community-acquired pneumonia and needs amoxicillin. She has carried a "penicillin allergy" label since age 2, when she developed a widespread maculopapular rash on day 5 of amoxicillin given for a viral illness; there was no swelling, breathing difficulty, blistering or mucosal involvement, and the label has never been evaluated. ^[3]

Your tasks are: ^[10]

1. Explain to the parent that the penicillin-allergy label is most likely false, and why, in plain language. ^[3]
2. Outline the safe delabelling pathway — a structured history, a risk check (PEN-FAST), and a supervised oral amoxicillin challenge. ^[2]
3. Explain the benefit of removing the label: restoring first-line penicillin and avoiding broader-spectrum, more problematic antibiotics. ^[9]
4. Address the parent's concern and surprise about challenging a child they were told was allergic. ^[1]

You are not expected to perform the challenge yourself in the station — you are explaining the pathway and the plan. Flag that the challenge is done under observation with the capacity to treat any reaction, so it is safe. ^[1]