Penicillin allergies: referral and management practices of anesthesiologists

Jain, Vipul; Joshi, Naresh; Sidhu, Mandeep S.; Kalicinsky, Chrystyna; Pun, Teresa

doi:10.1186/1710-1492-10-s2-a20

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…There has been increasing attention on preventing surgical site infections (SSI) with timely administration of preoperative antibiotics . Unfortunately, inaccurate or unconfirmed penicillin or B‐lactam allergy and misconceptions surrounding cephalosporin cross‐reactivity mean that many patients do not receive optimum prophylaxis, or it is avoided . In one adult study, patients with a penicillin allergy label had a 50% increased risk of SSI attributed to using the recommended penicillin alternative antibiotics .…”

Section: Discussionmentioning

confidence: 99%

Allergy alerts — The incidence of parentally reported allergies in children presenting for general anesthesia

Sommerfield

Schilling

et al. 2018

Pediatric Anesthesia

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Summary Background and aim Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent‐reported allergies in children presenting for surgery and its significance for anesthetists. Methods We prospectively collected data on admissions through our surgical admission unit over a 2‐month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anesthetist reviewed the documentation of all patients reporting an allergy. Results We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent‐reported allergies; to medications/drugs (n = 73), food (n = 66), environmental allergens (dust/grasses, n = 35), tapes/dressings (n = 27), latex (n = 4), and venom (eg, bee, wasp, n = 9). Forty‐one patients reported antibiotic allergies, with Beta‐lactam antibiotics being the most common, with the majority presenting with rash alone (57%). Ten patients reported allergies to nonsteroidal anti‐inflammatory drugs and eight to opioids. Twenty‐four patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE‐mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow‐up. Just four patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anesthesia practice. Conclusion Only the minority of parent‐reported allergies in pediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self‐reported food allergy is commonly specialist verified whereas reactions to medications were generally not. Over‐reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent‐reported reactions is urgently needed.

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Section: Discussionmentioning

confidence: 99%

Allergy alerts — The incidence of parentally reported allergies in children presenting for general anesthesia

Sommerfield

Schilling

et al. 2018

Pediatric Anesthesia

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“…As the impact of the 'penicillin allergic' label on antimicrobial stewardship and health costs becomes clearer, the need to find ways of reducing the burden of incorrect labels has become imperative. A key part of the problem is poor understanding of allergy amongst non-specialists (and patients) leading to incorrect labelling, and limited knowledge of the services available for allergy testing, 47,48 although there is evidence that knowledge can be improved through training. 49 These aspects are beyond the scope of this article.…”

Section: Novel Testing Strategies and Pathwaysmentioning

confidence: 99%

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Savic

Khan

Kopač

et al. 2019

British Journal of Anaesthesia

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Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

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