Comparative Effectiveness, Safety, and Real-World Outcomes of a Nurse-Led, Protocol-Driven Penicillin Allergy Evaluation From the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI)

A case of persistent IgE sensitisation almost two decades following ampicillin anaphylaxis

“…2 In fact, the duration since the reported index reaction is associated with lower risk of genuine penicillin allergy and often used as a parameter for risk stratification. [3][4][5][6] However, we report a case which illustrates that a cautious approach may still be warranted in patients with a history of severe reaction to penicillin regardless of the duration since the reported index reaction.…”

Differences in beta-lactam and penicillin allergy: Beyond the West and focusing on Asia-Pacific

“…A popular and important tactic adopted in many clinical settings is to stratify and triage patients into different groups according to their risk of a genuine allergy. Various clinical predictors have been validated to identify low, medium and high-risk features of genuine BL allergy ( 18 , 33 , 45 , 53 , 57 ). Studies have shown that risk triage by a comprehensive history alone purports an excellent negative predictive value for low-risk cases which is comparable to skin testing ( 45 , 58 , 59 ).…”

“…With proper risk stratification, further drug allergy workup strategies may be adopted to incorporate a multidisciplinary team with collaboration between Allergists, non-allergists and allied health professionals. Various clinical models that have gained popularity in the past decade include multidisciplinary collaborations with pharmacists, nurses, and non-allergist physicians to implement BL allergy workup among low-risk patients ( 16 – 18 , 68 ). With appropriate guidance and training, non-allergists have shown to independently evaluate low-risk cases and conduct delabelling.…”

“…For example, the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI) has published consensus statements to guide penicillin allergy testing by non-allergists and delabelling is now performed by non-allergists in various “Spoke” Clinics across Hong Kong supported by an Allergist in the “Hub” under a “Hub-and-Spoke” model ( 53 ). In fact, experience from HK-DADI has demonstrated that a nurse-led, protocol-driven evaluation was not only safe and effective in penicillin allergy delabelling, but led to an even higher rate of future penicillin use following delabelling and mitigated the need for unnecessary skin testing ( 18 ).…”

“…BL allergy labels are also associated with higher mean antibiotic costs, as well as higher cost during hospital admission and discharge, wherein lengthier hospital stays increase healthcare expenditure up to ten-fold ( 15 ). BL allergy delabelling has been shown to effectively reduce prescriptions of second-line antibiotics and promote re-uptake of first-line penicillins in delabelled patients ( 16 – 18 ). From Australian experience, antibiotic stewardship was enhanced with increased narrow-spectrum penicillin usage ( 19 ), with a low risk of anaphylaxis recurrence ( 20 ).…”