TABLE 4.

Themes and Quotes for Decision Process

Theme	Quote
Attitudes and Beliefs – believes child is allergic	“Benefit? I don’t know, it seems weird that that would ... Since we’ve had enough reactions, we feel like that’s a ... I guess I would have more questions. Then what is it that she’s allergic to? If these hives continue to happen every time she takes it, how’s that not an allergic reaction?” (Parent 1, group 1, after diagnosis, after presentation)
Health team perception – lacks trust	“Well, I think as a parent, it makes you feel like they aren’t crediting you with knowing your child and knowing what to calm them. And then, it really creates a barrier with that physician, especially when they say that because you don’t have a trusting relationship then, because they’re doubting what you say. And then, you’re doubting them listening to you. So, it creates mistrust.” (Parent 3, group 3, after diagnosis)
Perceived susceptibility- severe	“So, I’m always terrified to rock the boat at all, but I would like it if she could take PCN. I mean, it would make everything easier for her. I’m just so terrified, especially with her being so little. This has been happening since she was about 14 months, every time she gets a virus or allergies, we have to go to the hospital in the middle of the night.” (Parent 1, group 3, after diagnosis)
Perceived benefits – less worry	So, it would be nice. It would be really nice to have that off of my list of worries, and it would also be nice for her to have a stronger option for when she does get ear infections or something. That would be the benefit.” (Parent 1, group 3, undetermined diagnosis time frame)
Perceived benefits – more options	“And then also, the fact that they will have more options and possibility of less side effects, because we know the stronger the antibiotics the worse the side effects can get … Yeah, so basically, just 1 less thing to worry about, and more choices of antibiotics, because it’s like, for an ear infection or a skin infection, you jump right to a much stronger antibiotic than you really need if you don’t have a real, true PCN allergy.” (Parent 4, group 3, after diagnosis, after presentation)
Perceived benefits - positive	“Okay. For us, it would definitely be worth it, I think. I mean, she doesn’t get sick very often, but I think of all the times that she gets strep throat or something like that, and if we could use a PCN instead it would be great.” (Parent 3, group 3, after diagnosis)
Perceived benefits – good news	“I was encouraged. It was just nice to have. We get a lot of bad news in doctor’s offices. And so, it was nice just to be like, ‘Hey, this is a win.’ So, I remember just being encouraged by that.” (Parent interview, After diagnosis, Interview delabeled)
Perceived benefits – complicated medical history	“And so, knowing those complexities, and knowing that they’re never going to go away, I want care to be as seamless, and easy for her as possible. So, removing a PCN allergy seems like, ‘Oh, I mean, it was pretty simple.’” (Parent interview, Undetermined diagnosis time frame, Interview delabeled)
Perceived benefits - cost	“…and my 6 year old’s PCN is $7, and my 3 year old’s whatever they give her is 4 times or 5 times as much. That’s the only difference, really, is that her antibiotics are so much more expensive because she can’t take PCN.” (Parent 1, group 3, mixed)
Thoughts and emotions - anxiety	I don’t think I would really benefit from it because I would still be nervous, and I would still try to avoid it just because there are suitable alternatives. If that was my only option, I would be more open to it. But she’s likely to pass if they did a little test because she was on it for quite a few days before she had a reaction. Basically, it would change nothing for me, I would still try to avoid it.” (Parent 1, group 2, after diagnosis, after presentation)
Thoughts and emotions - relief	And, I would be less worried. As a parent, if she had the test, okay, she’s not allergic or it’s a very mild reaction. Being able to prescribe, would probably still flag her chart that way. Only use it if necessary. If it says, okay, she’s not allergic at all, then I would probably be willing to try that again.” (Parent 1, group 1, after diagnosis)
Thoughts and emotions – due diligence	I have to say that I have to choose my battle, which is, which one is worth for me to fight for? What is important and what is priority for me right now? Is it he’s allergic to amoxicillin? Is it his breathing? Is it something else? What is it right is priority to me, that I need to focus on?…” (Parent 2, group 3, after diagnosis)

“After” and “before” diagnosis refers to participants perceptions before the drug allergy reaction and subsequent diagnosis or after the reaction and diagnosis. Most of the discussion occurred following the group education on PCN allergies and the delabeling process.