A clinical decision-making algorithm for penicillin allergy
| Autor: | Angèle Soria, J.E. Autegarden, Camille Francès, Emmanuelle Amsler, H. Gaouar, Elodie Autegarden, Amandine Vial |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Allergy Pediatrics medicine.medical_specialty Adolescent Clinical Decision-Making Penicillin allergy Penicillins Sensitivity and Specificity Drug Hypersensitivity Young Adult 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Clinical decision making Risk Factors Humans Medicine Medical prescription Child Medical History Taking Aged Skin Tests Aged 80 and over Anamnesis business.industry General Medicine Gold standard (test) Middle Aged medicine.disease Predictive value Anti-Bacterial Agents Penicillin 030228 respiratory system Female business Algorithm Algorithms medicine.drug |
| Zdroj: | Annals of Medicine. 49:710-717 |
| ISSN: | 1365-2060 0785-3890 |
| Popis: | About 10% of subjects report suspected penicillin allergy, but 85-90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics Objective: To design and validate a clinical decision-making algorithm, based on anamnesis (chronology, severity, and duration of the suspected allergic reactions) and reaching a 100% sensitivity and negative predictive value, to assess allergy risk related to a penicillin prescription in general practise.All patients were included prospectively and explorated based on ENDA/EAACI recommendations. Results of penicillin allergy work-up (gold standard) were compared with results of the algorithm.Allergological work-up diagnosed penicillin hypersensitivity in 41/259 patients (15.8%) [95% CI: 11.5-20.3]. Three of these patients were diagnosed as having immediate-type hypersensitivity to penicillin, but had been misdiagnosed as low risk patients using the clinical algorithm. Thus, the sensitivity and negative predictive value of the algorithm were 92.7% [95% CI: 80.1-98.5] and 96.3% [95% CI: 89.6-99.2], respectively, and the probability that a patient with true penicillin allergy had been misclassified was 3.7% [95% CI: 0.8-10.4].Although the risk of misclassification is low, we cannot recommend the use of this algorithm in general practice. However, the algorithm can be useful in emergency situations in hospital settings. Key messages True penicillin allergy is considerably lower than alleged penicillin allergy (15.8%; 41 of the 259 patients with suspected penicillin allergy). A clinical algorithm based on the patient's clinical history of the supposed allergic event to penicillin misclassified 3/41 (3.7%) truly allergic patients. |
| Databáze: | OpenAIRE |
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