Lene H Garvey1,2, Louise C Savic3. 1. Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of dermatology and allergy, Copenhagen University Hospital Gentofte. 2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 3. Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Abstract
PURPOSE OF REVIEW: This review aims to describe current best practice and recent advances in the use of risk stratification as a tool for drug provocation testing (DPT). In particular, we focus on the testing of unsubstantiated penicillin allergy labels. RECENT FINDINGS: The inherent risks of DPT are mitigated through careful selection of patients. A detailed history will elicit features of a potentially severe index reaction, as well as significant patient comorbidities which may increase the risks associated with DPT. Such patients require skin testing and/or in vitro testing prior to consideration for a DPT. However, there is increasing evidence that patients without these features may be able to proceed directly to DPT. This has been demonstrated extensively with unsubstantiated penicillin allergy labels, and a variety of risk stratification models have been employed to identify the 'low-risk' patient. Improved outcomes and reduced cost have been demonstrated with such models without compromising patient safety. SUMMARY: Risk stratification tools may enable well-tolerated and effective 'delabelling' of low-risk patients, with less demand on already scarce resources.
PURPOSE OF REVIEW: This review aims to describe current best practice and recent advances in the use of risk stratification as a tool for drug provocation testing (DPT). In particular, we focus on the testing of unsubstantiated penicillinallergy labels. RECENT FINDINGS: The inherent risks of DPT are mitigated through careful selection of patients. A detailed history will elicit features of a potentially severe index reaction, as well as significant patient comorbidities which may increase the risks associated with DPT. Such patients require skin testing and/or in vitro testing prior to consideration for a DPT. However, there is increasing evidence that patients without these features may be able to proceed directly to DPT. This has been demonstrated extensively with unsubstantiated penicillinallergy labels, and a variety of risk stratification models have been employed to identify the 'low-risk' patient. Improved outcomes and reduced cost have been demonstrated with such models without compromising patient safety. SUMMARY: Risk stratification tools may enable well-tolerated and effective 'delabelling' of low-risk patients, with less demand on already scarce resources.