The role of a clinical pharmacist in spurious Penicillin allergy: a narrative review

Bhogal, Rashmeet; Hussain, Abid; Balaji, Ariyur; Bermingham, William; Marriott, John; Krishna, Mamidipudi Thirumala

doi:10.1007/s11096-020-01226-7

Cited by 10 publications

(7 citation statements)

References 48 publications

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“…Experience from penicillin allergy de-labelling has provided great insight into the multifactorial negative impact of allergy labels on patients and healthcare systems and a need for a structured and standardised 'real time' data capture and assessment of ADR episodes. [53][54][55] Application of a standardised e-tool at bedside alongside education of healthcare professionals may facilitate such an approach. 56,57…”

Section: Adr S and H S R S To Anti -Tb Drug Smentioning

confidence: 99%

“…The proposed structure draws on first principles of drug allergy management and lessons learnt from the management of 'true' penicillin allergy, and recently applied concept of direct oral penicillin challenge in 'low risk' patients with penicillin allergy labels. 9,13,54 SCARs present a particularly challenging group due to systemic involvement and must be distinguished from other forms of delayed HSR.…”

Section: Is There Pl Ace For a Pr Ag Mati C Approach To Manag Ement O...mentioning

confidence: 99%

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Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Bermingham

Bhogal

Nagarajan³

et al. 2022

Clin Experimental Allergy

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Tuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low-Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)-TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti-TB drugs occur in over 60% and 3%-4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR-TB. HSRs to anti-TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T-cell mediated. Severe and systemic T-cell mediated HSRs and IgE mediated anaphylaxis to anti-TB drugs are relatively rare, but important to recognise and treat promptly. T-cellmediated HSRs are more frequent amongst patients with co-existing HIV infection.

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Section: Adr S and H S R S To Anti -Tb Drug Smentioning

confidence: 99%

Section: Is There Pl Ace For a Pr Ag Mati C Approach To Manag Ement O...mentioning

confidence: 99%

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Bermingham

Bhogal

Nagarajan³

et al. 2022

Clin Experimental Allergy

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“…There has been much interest in programs to delabel suspected penicillin allergy both in adults and children, in particular in antimicrobial stewardship programs to prevent widespread use of alternative broad spectrum non-penicillin antibiotics which may lead to antimicrobial resistance and use of agents that may not be as effective as penicillins ( 10 – 13 ). Clinical pharmacist and nurse-led allergist supervised delabelling programs for low-risk index reactors have been shown to be safe, effective and potentially scalable ( 13 , 14 ). Guidelines for penicillin allergy delabelling services in children and adults by non-allergists working in hospital settings, networked with a specialist allergy immunology service for advice and support, have also been published ( 15 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Delabelling multiple antibiotic allergy: Practical issues

Thong

2023

Front. Allergy

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With the growing incidence of multi-drug resistant organisms, delabelling incorrect antibiotic allergies has become an integral part of antimicrobial stewardship worldwide. For example, around 90% of penicillin allergy labels are found to be inaccurate following a full allergy work-up, which deprive patients the use of effective first-line penicillin antibiotics and increase the risk of antimicrobial resistance with the use of other extended spectrum non-penicillin antimicrobials. Significant numbers of adult and paediatric patients over time are labelled with multiple penicillin and non-penicillin antibiotic allergies often during inappropriate antimicrobial use, resulting in a label of “multiple antibiotic allergy”. In contrast to delabelling penicillin allergy where oral direct provocation tests can be used for low-risk, mild reactions, and sensitivity/specificity/positive and negative predictive values of skin tests have been demonstrated, diagnostic tests for multiple antibiotic allergy often require the use of a combination of in-vivo and in-vitro tests across different antimicrobial classes for evaluation. Shared decision making with patients and informed consent are also needed when prioritising which drugs to delabel first, balancing the risks, benefits of testing vs. interim use of alternative antibiotics. Similar to delabelling penicillin allergy, the cost-effectiveness of delabelling multiple drug allergies is unknown.

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“…Between 90% and 95% of penicillin allergy labels are inaccurate, leading to prescription of expensive broad‐spectrum antibiotics which enhance risk of antimicrobial resistance, Clostridioides difficile infection, surgical site infections, lengthen hospital stay and increase healthcare costs. 7 , 8 , 9 Reported penicillin allergy, with or without multiple drug intolerance (MDI) syndrome has been shown to increase healthcare utilization with an increase in number of visits per follow‐up. 8 Poor documentation and knowledge gaps amongst healthcare professionals have been linked to inaccurate penicillin allergy labelling.…”

Section: Introductionmentioning

confidence: 99%

“…Inaccurate drug allergy labelling has been extensively studied in high income countries (HICs) in the context of penicillin allergy labels. Between 90% and 95% of penicillin allergy labels are inaccurate, leading to prescription of expensive broad‐spectrum antibiotics which enhance risk of antimicrobial resistance, Clostridioides difficile infection, surgical site infections, lengthen hospital stay and increase healthcare costs 7–9 . Reported penicillin allergy, with or without multiple drug intolerance (MDI) syndrome has been shown to increase healthcare utilization with an increase in number of visits per follow‐up 8 .…”

Section: Introductionmentioning

confidence: 99%

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Jagpal

Alshareef

Marriott

et al. 2022

Clinical & Translational All

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Background Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco‐economics of MDAS and MDIS. Methods Systematic literature search across 11 databases (01 January 2000–06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted. Results There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%–6.4% & 4.9%–90% and 1.2% & 0%–36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co‐morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non‐steroidal anti‐inflammatory drugs. No studies relating to clinical impact and pharmaco‐economics were found. Conclusion There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well‐designed multi‐centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.

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The role of a clinical pharmacist in spurious Penicillin allergy: a narrative review

Cited by 10 publications

References 48 publications

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Delabelling multiple antibiotic allergy: Practical issues

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

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