Tracy Zembles1, Michelle Mitchell2, Waleed Alqurashi3, Mariana Castells4, Elizabeth J Phillips5, David Vyles6. 1. Department of Enterprise Safety, Children's Wisconsin, Milwaukee, WI, USA. 2. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. 3. Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. 4. Divison of Rheumatology, Immunology, and Allergy, Harvard Medical School, Harvard University, and Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. dvyles@mcw.edu.
Abstract
PURPOSE OF REVIEW: Self-reported penicillin allergies are frequently reported, though more than 95% of those are not truly allergic when challenged. These patients are more likely to receive alternative antibiotic regimens resulting in the use of broad-spectrum antibiotics that may be less effective, more toxic, and/or more expensive than preferred agents. Given the significant burden on patient outcomes and the healthcare system, the ability to reconcile an allergy and broaden future antibiotic options is essential. RECENT FINDINGS: This is a narrative review describing risk stratification for penicillin skin testing, practical advice for implementation, and future directions. A summary of studies within the last 5 years is provided. The trend over the past several years has been to offer oral drug challenges to low-risk patients and skin testing to high-risk patients with a reported penicillin allergy. This review provides support for risk stratification assessment of reported penicillin allergy to optimize antibiotic use and prevent emergence of antimicrobial resistance.
PURPOSE OF REVIEW: Self-reported penicillin allergies are frequently reported, though more than 95% of those are not truly allergic when challenged. These patients are more likely to receive alternative antibiotic regimens resulting in the use of broad-spectrum antibiotics that may be less effective, more toxic, and/or more expensive than preferred agents. Given the significant burden on patient outcomes and the healthcare system, the ability to reconcile an allergy and broaden future antibiotic options is essential. RECENT FINDINGS: This is a narrative review describing risk stratification for penicillin skin testing, practical advice for implementation, and future directions. A summary of studies within the last 5 years is provided. The trend over the past several years has been to offer oral drug challenges to low-risk patients and skin testing to high-risk patients with a reported penicillinallergy. This review provides support for risk stratification assessment of reported penicillinallergy to optimize antibiotic use and prevent emergence of antimicrobial resistance.
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