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A Retrospective Critical Analysis and Risk Stratification of Penicillin Allergy De-labelling in a UK Specialist Regional Allergy Service.

Mohamed, Omar E and Beck, Sarah C and Huissoon, Aarnoud P and Melchior, Cathryn L and Heslegrave, Jane and Baretto, Richard and 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

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Official URL: https://www.sciencedirect.com/science/article/pii/...

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.heartofengland.nhs.uk/id/eprint/1672

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