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Mohamed, Omar E, Beck, Sarah C, Huissoon, Aarnoud P, Melchior, Cathryn L, Heslegrave, Jane, Baretto, Richard, Ekbote, Anjali and Krishna, Mamidipudi Thirumala (2018) A Retrospective Critical Analysis and Risk Stratification of Penicillin Allergy De-labelling in a UK Specialist Regional Allergy Service. The Journal of allergy and clinical immunology. ISSN 1097-6825. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Full text not available from this repository.Abstract
BACKGROUND
A spurious label of penicillin allergy (Pen-A) negatively impacts on antibiotic stewardship and healthcare costs. Recent studies have proposed a guideline-steered direct penicillin challenge without undertaking allergy tests when 'true allergy' is unlikely.
OBJECTIVE
Critically analyse Pen-A clinical presentation, perform risk stratification and determine clinical predictors for 'true allergy'.
METHOD
Retrospective data extraction from clinical and electronic patient records.
RESULTS
231 patients (M= 82; F=149; mean age 51.22 (SD ± 18.07 years) were analysed. Based on clinical history, patients were categorised as likely type I hypersensitivity [HSR] (n=27), likely type IV HSR (n=65), indeterminate (n=111) and HSR unlikely (n=28). Based on index reaction and co-morbidities, patients were classified into 'low risk' (n=143) and 'high risk' (n=78). Pen-A was excluded in 74% of patients assessed having likely type I HSR, 91% with likely type IV HSR, 93% of indeterminate and 100% of HSR unlikely patients. Negative predictive value for successful de-labelling in the 'low risk' group was 94% (odds ratio [OR] - 2.9; p= 0.02). Predictors for 'true Pen-A' were history of anaphylaxis (OR - 30.6; p < 0.001), hospitalization (OR - 7; p<0.001), ≤5 years since index reaction (OR - 3; p= 0.04).
CONCLUSION
Systematic clinical characterisation and risk stratification has an important role in Pen-A de-labelling. These data provide proof of concept for a guideline-based selection of patients labelled with Pen-A for a direct penicillin challenge. Patients in the 'low risk' group seem suitable for this intervention, although a rigorous prospective evaluation is needed in a multi-centre study.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs |
| Subjects: | QW Microbiology. Immunology |
| Divisions: | Clinical Support |
| Related URLs: | |
| Depositing User: | Mrs Caroline Tranter |
| Date Deposited: | 28 Jun 2018 14:32 |
| Last Modified: | 28 Jun 2018 14:32 |
| URI: | http://www.repository.uhblibrary.co.uk/id/eprint/1672 |
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