Implementing a penicillin allergy de-labelling service for the obstetric population

Zhang, Bei Yuan; McClymont, Elisabeth; Paquette, Vanessa; Watt, Melissa H.; Albert, Arianne; Bloomfield, Anna; Butler, Blair; Shields, Andrew; Kowalska, Edyta; Mak, Raymond; Elwood, Chelsea

doi:10.1016/j.jogc.2020.02.122

Cited by 1 publication

(2 citation statements)

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“…Implementation of routine testing of pregnant women with PALs has shown to be both safe and effective in allowing optimal antibiotic therapy [58,59 ▪ ,60]. Programs have applied the PEN-FAST scoring system to perform risk-stratification with direct oral challenges in low-risk pregnant women [22 ▪▪ ,58]. These reports are noteworthy as they have demonstrated a safety profile for risk-stratified testing in pregnant women which is equivalent to what has been observed in nonpregnant populations.…”

Section: Special Populationsmentioning

confidence: 99%

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Advances in immunoglobulin E mediated antibiotic allergy

Rukasin

Phillips

Stone

2022

Current Opinion in Pediatrics

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Purpose of reviewThe purpose of this review is to identify recent advances in our understanding and management of immunoglobulin E (IgE)-mediated antibiotic allergy.Recent findingsAntibiotics remain a leading cause of fatal anaphylaxis reported to the FDA. However, recent advances have defined the features of adult and pediatric patients without true IgE-mediated allergy or any mechanism of anaphylaxis when tested. This has created opportunities to use direct challenges to disprove these allergies at the point-of-care and improves antibiotic stewardship. Additional advances have highlighted cross-reactive structural considerations within classes of drugs, in particular the R1 side-chain of cephalosporins, that appear to drive true immune-mediated cross-reactivity. Further advances in risk-based approaches to skin testing, phenotyping, and re-exposure challenges are needed to standardize antibiotic allergy evaluation.SummaryRecent advances in defining true IgE-mediated drug allergy have helped to identify patients unlikely to be skin-test positive. In turn, this has identified patients who can skip skin testing and proceed to direct ingestion challenge using history risk-based approaches. The ability to identify the small number of patients with true IgE-mediated allergy and study their natural history over time, as well as the vast majority without true allergy will facilitate important and novel mechanistic discoveries.

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Section: Special Populationsmentioning

confidence: 99%

Section: Special Populationsmentioning

confidence: 99%