Jamma Li1, Aryan Shahabi-Sirjani2, Melanie Figtree3, Philip Hoyle4, Suran L Fernando5. 1. Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia. Electronic address: jamma.li@health.nsw.gov.au. 2. Department of Pharmacy, Northern Sydney Local Health District, Sydney, Australia. 3. New South Wales Health Pathology, Sydney, Australia; Department of Infectious Diseases, Royal North Shore Hospital, Sydney, Australia. 4. Executive Unit, Northern Sydney Local Health District, Sydney, Australia. 5. Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia; University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: Nonprescription of penicillin-containing antibiotics in patients diagnosed with penicillin allergy is associated with morbidity and mortality. Adverse reactions to penicillins comprise type A and B reactions. OBJECTIVE: To assess the feasibility of penicillin allergy evaluation without penicillin skin testing (PST) for adult patients with type B reactions and the health and economic benefits of this process. METHODS: Inpatients at an Australian tertiary hospital between April 1, 2017, and April 30, 2018, with a diagnosis of type B penicillin allergy, requiring a penicillin-containing antibiotic for treatment, were included. All patients underwent clinical history review, PST, and drug provocation testing (DPT). RESULTS: Seventy-one patients were enrolled. Sixty-three reported a history of type B or unknown adverse reactions. No patients had a history of anaphylaxis requiring intubation or epinephrine within the last 10 years or a history suggesting Gell and Coombs type 2, 3, or 4 (severe) hypersensitivity reaction. Seven did not complete DPT because the treating team used a β-lactam antibiotic other than amoxicillin. Fifty-four of 56 remaining patients (96%) completed 3-day DPT to amoxicillin with no adverse reaction. Two experienced mild cutaneous reactions. Penicillin allergy evaluation was significantly associated with reduced length of stay, reduced hospital expenditure on bed and second-line antibiotics, and reduced readmission rates. CONCLUSION: Penicillin allergy evaluation with DPT without PST may be feasible for all adult patients with a reported history of type B reactions to penicillins who do not have a history of anaphylaxis within the last 10 years or a type 2, 3, or 4 (severe) hypersensitivity reaction.
BACKGROUND: Nonprescription of penicillin-containing antibiotics in patients diagnosed with penicillinallergy is associated with morbidity and mortality. Adverse reactions to penicillins comprise type A and B reactions. OBJECTIVE: To assess the feasibility of penicillinallergy evaluation without penicillin skin testing (PST) for adult patients with type B reactions and the health and economic benefits of this process. METHODS: Inpatients at an Australian tertiary hospital between April 1, 2017, and April 30, 2018, with a diagnosis of type B penicillinallergy, requiring a penicillin-containing antibiotic for treatment, were included. All patients underwent clinical history review, PST, and drug provocation testing (DPT). RESULTS: Seventy-one patients were enrolled. Sixty-three reported a history of type B or unknown adverse reactions. No patients had a history of anaphylaxis requiring intubation or epinephrine within the last 10 years or a history suggesting Gell and Coombs type 2, 3, or 4 (severe) hypersensitivity reaction. Seven did not complete DPT because the treating team used a β-lactam antibiotic other than amoxicillin. Fifty-four of 56 remaining patients (96%) completed 3-day DPT to amoxicillin with no adverse reaction. Two experienced mild cutaneous reactions. Penicillinallergy evaluation was significantly associated with reduced length of stay, reduced hospital expenditure on bed and second-line antibiotics, and reduced readmission rates. CONCLUSION:Penicillinallergy evaluation with DPT without PST may be feasible for all adult patients with a reported history of type B reactions to penicillins who do not have a history of anaphylaxis within the last 10 years or a type 2, 3, or 4 (severe) hypersensitivity reaction.
Authors: Kyra Y L Chua; Sara Vogrin; Susan Bury; Abby Douglas; Natasha E Holmes; Nixon Tan; Natasha K Brusco; Rebecca Hall; Belinda Lambros; Jacinta Lean; Wendy Stevenson; Misha Devchand; Kent Garrett; Karin Thursky; M Lindsay Grayson; Monica A Slavin; Elizabeth J Phillips; Jason A Trubiano Journal: Clin Infect Dis Date: 2021-08-02 Impact factor: 9.079
Authors: Bernard Yu-Hor Thong; Michaela Lucas; Hye-Ryun Kang; Yoon-Seok Chang; Philip Hei Li; Min Moon Tang; James Yun; Jie Shen Fok; Byung-Keun Kim; Mizuho Nagao; Iris Rengganis; Yi-Giien Tsai; Wen-Hung Chung; Masao Yamaguchi; Ticha Rerkpattanapipat; Wasu Kamchaisatian; Ting Fan Leung; Ho Joo Yoon; Luo Zhang; Amir Hamzah Abdul Latiff; Takao Fujisawa; Francis Thien; Mariana C Castells; Pascal Demoly; Jiu-Yao Wang; Ruby Pawankar Journal: Asia Pac Allergy Date: 2020-01-30