Single-step direct drug provocation testing is safe for delabelling selected non–low-risk penicillin allergy labels
| Autor: | Suran L. Fernando, Vera Cvetanovski, Jamma Li |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Risk Pulmonary and Respiratory Medicine medicine.medical_specialty Allergy Adolescent Immunology Provocation test Drug allergy Cefazolin Penicillins Risk Assessment Bronchial Provocation Tests Drug Hypersensitivity Young Adult 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Immunology and Allergy Prospective Studies 030212 general & internal medicine Child Aged Aged 80 and over business.industry Amoxicillin Infant Middle Aged medicine.disease Rash Penicillin 030228 respiratory system Child Preschool Female medicine.symptom business Anaphylaxis medicine.drug |
| Zdroj: | Annals of Allergy, Asthma & Immunology. 127:232-235 |
| ISSN: | 1081-1206 |
| Popis: | Background Penicillin allergy labels are prevalent, and removal of incorrect labels improves patient outcomes and health economics. Labels may be classified as “low-risk” or “non–low-risk,” of which the symptoms of the latter chiefly suggest immunoglobulin E–mediated etiology. Traditionally, “non–low-risk” allergy labels are evaluated by penicillin skin testing followed by graded multistep penicillin drug provocation testing (DPT). Objective To evaluate the safety of assessing “non–low-risk” labels with single-step direct DPT. Methods We consecutively enrolled inpatients and outpatients of a teaching hospital in Sydney, Australia, with penicillin allergy labels requiring penicillin for first-line treatment. Patients were classified as “low-risk” or “non–low-risk” based on the allergy labels. All patients proceeded directly to amoxicillin DPT, unless there was a history of anaphylaxis within 10 years of assessment to a beta-lactam (except for cefazolin) or Gell and Coombs type 2, type 3, or severe type 4 reaction. This was followed by a course of amoxicillin. Results A total of 149 patients (41 inpatients, 108 outpatients) were enrolled. No patient was excluded from the study. No patient experienced life-threatening reactions to the protocol. There were 85 patients who reported “non–low-risk” allergy labels. One patient developed generalized pruritus and rash that resolved with standard-dose antihistamines, 2 developed delayed benign maculopapular exanthem, and 3 experienced diarrhea during the course of amoxicillin. Conclusion In our cohort, direct single-step DPT was safe, with only 6 patients with “non–low-risk” allergy experiencing benign reactions. We hope that further studies can be performed into single-step direct DPT to evaluate “non–low-risk” penicillin allergy labels. Trial Registration ClinicalTrials.gov Identifier: LNR/16/HAWKE/452. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|