Digital Antibiotic Allergy Decision Support Tool Improves Management of β-Lactam Allergies

Dunham, Theresa B.; Gardner, Rachel; Lippner, Elizabeth; Fasani, Danielle E.; Moir, Elwyn; Halpern‐Felsher, Bonnie; Sundaram, Vandana; Liu, Anne Y.

doi:10.1016/j.jaip.2023.01.026

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…However, the main barrier for delabeling by non-allergists is the lack of training in this area. Therefore, various measures have been developed recently to enhance the management of antibiotic allergy labeling by non-allergists to facilitate their decisions, including educational programs ( 153 ), and implementation of visual algorithmic guidelines, digital decision support tools, and electronic health record-incorporated tools and alerts ( 140 , 154 – 159 ). These measures have resulted in an increased confidence of non-allergists in managing antibiotic allergy labels and adherence to allergist recommendations, leading to a decrease in the use of broad-spectrum antibiotics for patients who previously reported penicillin allergies ( 140 , 154 – 159 ).…”

Section: Novel Approaches For Delabelingmentioning

confidence: 99%

Approach for delabeling beta-lactam allergy in children

Sáenz de Santa María,

Bogas,

Labella

et al. 2023

Front. Allergy

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A considerable number of pediatric patients treated with beta-lactam (BL) antibiotics develop delayed onset of skin rashes during the course of treatment. Although the most frequent cause of these symptoms is infectious, many cases are labeled as allergic reactions to these drugs. BL allergy labels could have a negative impact, as they imply avoidance of this group of drugs and the use of second-line antibiotics, leading to a potential increase in adverse effects and the utilization of less effective therapies. This constitutes a major public health concern and economic burden, as the use of broad-spectrum antibiotics can result in multidrug-resistant organisms and prolonged hospital stays. Therefore, it is crucial to delabel patients during childhood to avoid false labeling in adult life. Although the label of BL allergy is among the most frequent causes of allergy referral, its management remains controversial, and new diagnostic perspectives are changing the paradigm of managing BL allergies in children. Traditionally, drug provocation testing (DPT) was exclusively performed in patients who had previously obtained negative results from skin tests (STs). However, the sensitivity of STs is low, and the role of in vitro testing in the pediatric population is not well defined. Recent studies have demonstrated the safety of direct DPT without prior ST or serum tests for pediatric patients who report a low-risk reaction to BLs, which is cost-effective. However, there is still a debate on the optimal allergic workup to be performed in children with a benign immediate reaction and the management of children with severe cutaneous adverse drug reactions. In this review, we will discuss the impact of the label of BL allergy and the role of the different tools currently available to efficiently address BL allergy delabeling in children.

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Section: Novel Approaches For Delabelingmentioning

confidence: 99%

Approach for delabeling beta-lactam allergy in children

Sáenz de Santa María,

Bogas,

Labella

et al. 2023

Front. Allergy

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Computer-Assisted Clinical Diagnosis and Treatment

Hamid

Portnoy

Pandya

2023

Curr Allergy Asthma Rep

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Is the Anamnesis Enough to De-Label Patients with Reported Beta-Lactam Allergy?

Rozłucka,

Rymarczyk,

Gawlik

et al. 2024

JCM

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Background: The decision whether to de-label patient with suspected BL hypersensitivity is based on risk stratification. The aim of this study was to prepare a characteristic of diagnostic risk groups and to create a model enabling the identification of the low-risk diagnostic group. Methods: We analyzed the medical records of patients hospitalized due to suspected hypersensitivity to BL antibiotics. Based on their medical-history data, patients were divided into three diagnostic risk groups, using the criteria proposed by Shenoy et al. Univariate and multivariate analysis models were used to create a diagnostic tool. Results: Among 263 patients referred for BL hypersensitivity diagnosis, 88 (33.5%) were allocated to group I, 129 (49%) to group II, and 46 (17.5%) to group III. There were significant differences between diagnostic risk groups regarding history of hypersensitivity to penicillins (p < 0.001), cephalosporins (p < 0.001), >1 BL (p < 0.05), several episodes of BL hypersensitivity (p < 0.001), medical intervention (p < 0.001), documented hypersensitivity (p < 0.001), time from drug intake to symptoms (p < 0.001), and time from hypersensitivity to diagnosis (p < 0.001). In total, 81 patients (30.8%) were de-labeled: 52 (59.8%) in group I, 27 (20.9%) in group II, and 2 (4.3%) in group III. The univariate analysis model of the low-diagnostic-risk group applied to the de-labeled part showed 90% specificity and 21.93% sensitivity. NPV and PPV were estimated at 72.04% and 49.53%, respectively. The multivariate model had high specificity but low sensitivity; its NPV was 76%, with 68% PPV. Conclusions: The tool enabling the identification of low-diagnostic-risk patients based on anamnesis is not sensitive enough to de-label patients on its basis.

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Digital Antibiotic Allergy Decision Support Tool Improves Management of β-Lactam Allergies

Cited by 3 publications

References 21 publications

Approach for delabeling beta-lactam allergy in children

Approach for delabeling beta-lactam allergy in children

Computer-Assisted Clinical Diagnosis and Treatment

Is the Anamnesis Enough to De-Label Patients with Reported Beta-Lactam Allergy?

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