De‐labelling self‐reported penicillin allergy within the emergency department through the use of skin tests and oral drug provocation testing

Marwood, J; Aguirrebarrena, Gonzalo; Kerr, Stephen J.; Welch, Susan; Rimmer, Janet

doi:10.1111/1742-6723.12774

Cited by 39 publications

(37 citation statements)

References 19 publications

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“…Recent work by Trubiano et al . identified that 24% of patients in acute care units, including ICU, had an AAL , while more specifically, up to 8–12% of patients in the emergency department and 8% in the ICU have a penicillin AAL . The reason for this high prevalence of AALs is probably multifactorial and includes those accumulated in childhood during a concurrent viral illness (e.g.…”

Section: Methodsmentioning

confidence: 99%

Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

Moran

Devchand

Smibert

et al. 2019

Brit J Clinical Pharma

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Antibiotic allergy labels (AALs) are reported by approximately 20% of hospitalized patients, yet over 85% will be negative on formal allergy testing. Hospitalized patients with an AAL have inferior patient outcomes, increased colonization with multidrugresistant organisms and frequently receive inappropriate antimicrobials. Hospitalized populations have been well studied but, to date, the impact of AALs on patients with critical illness remains less well defined. We review the prevalence and impact of AALs on hospitalized patients, including those in in critical care. We performed a narrative review, examining literature via the Medline (Ovid) platform (September 2017 and February British Journal of Clinical Pharmacology Br J Clin Pharmacol (2019) 85 492-500 492 Adapted from Trubiano et al. (with permission) [25, 58], Gell and Coombs [16], Pichler [19]. Comparative table of the different type B adverse drug reactions and their immunological components, clinical presentations and time frames. SJS, Stevens-Johnsons syndrome; TEN, toxic epidermal necrosis; DRESS, drug reaction with eosinophilia and systemic symptoms Review of antibiotic allergy impacts in hospitalized adults Br J Clin Pharmacol (2019) 85 492-500 493 Review of antibiotic allergy impacts in hospitalized adults Br J Clin Pharmacol (2019) 85 492-500 499

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Section: Methodsmentioning

confidence: 99%

Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

Moran

Devchand

Smibert

et al. 2019

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…After testing in this cohort, guideline‐preferred antibiotic prescribing significantly improved (95% [3 months after implementation] v 62% [3 months before implementation]), as did antibiotic appropriateness (adjusted OR, 12.27; 95% CI, 5.00–30.09) 21 . In another recent Australian study using allergy testing in an emergency department, 81% of patients had their penicillin allergy label removed following penicillin skin testing and oral provocation 22 …”

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confidence: 82%

How antibiotic allergy labels may be harming our most vulnerable patients

Trubiano

Grayson

Thursky

et al. 2018

Medical Journal of Australia

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“…There have been a number of international initiatives to de‐label patients with amoxicillin allergy including through the American Academy of Allergy, Asthma and Immunology and the North American Choosing Wisely initiatives . There has also been a surge of studies aiming to de‐label beta‐lactam allergy, including perioperative programmes, pharmacy‐led programmes, inpatient programmes and Emergency Department‐led programmes, which have demonstrated resounding success at de‐labelling this allergy and improving antibiotic stewardship in both inpatient and outpatient settings…”

Section: The Necessity Of Ruling Out Amoxicillin Allergy In Childrenmentioning

confidence: 99%

Should testing be initiated prior to amoxicillin challenge in children?

Abrams

Ben‐Shoshan

2019

Clin Experimental Allergy

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Amoxicillin is the most common antibiotic prescribed in children with increasing use over time. While up to 10% of children are labelled as amoxicillin allergic, most children can tolerate amoxicillin after allergy evaluation. It is well documented that the label of amoxicillin allergy in children is associated with adverse health outcomes such as antibiotic-resistant infections. However, it remains controversial how best to assess children for amoxicillin allergy. While in general it is recommended that skin testing be done prior to drug provocation test in the evaluation of amoxicillin allergy, there is increasing evidence that drug provocation testing could be done in lower risk children without skin testing prior. The goal of this article as a narrative review is to review the strengths and limitations of skin testing prior to drug provocation test in children who have a history of either immediate or non-immediate, reactions to amoxicillin. K E Y W O R D Sanaphylaxis, drug allergy, immunologic tests

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De‐labelling self‐reported penicillin allergy within the emergency department through the use of skin tests and oral drug provocation testing

Cited by 39 publications

References 19 publications

Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

How antibiotic allergy labels may be harming our most vulnerable patients

Should testing be initiated prior to amoxicillin challenge in children?

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