Safety of direct drug provocation testing in adults with penicillin allergy and association with health and economic benefits
| Autor: | Suran L. Fernando, Melanie Figtree, Philip Hoyle, Jamma Li, Aryan Shahabi-Sirjani |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.drug_class medicine.medical_treatment Immunology Antibiotics Provocation test Drug Hypersensitivity Tertiary Care Centers Internal medicine medicine Immunology and Allergy Intubation Humans Adverse effect Diagnostic Techniques and Procedures Aged Inpatients business.industry Australia Amoxicillin medicine.disease Anti-Bacterial Agents Penicillin Hypersensitivity reaction Female business Anaphylaxis medicine.drug |
| Zdroj: | Annals of allergy, asthmaimmunology : official publication of the American College of Allergy, Asthma,Immunology. 123(5) |
| ISSN: | 1534-4436 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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