Direct oral amoxicillin challenge without preliminary skin testing in adult patients with allergy and at low risk with reported penicillin allergy

Kuruvilla, Merin; Shih, Jennifer; Patel, Kiran; Scanlon, Nicholas

doi:10.2500/aap.2019.40.4184

Cited by 55 publications

(49 citation statements)

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“…Despite these efforts, patients may still not be able to accurately answer all of these questions, which makes appropriate assessment for clinicians challenging, especially when many of the answers to the questions are unknown. In patients deemed higher risk for a true allergic reaction or with an unknown allergy history, PST is a helpful management option in the outpatient setting [18,19,20,21].…”

Section: Penicillin Allergy Interview Assessmentmentioning

confidence: 99%

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

et al. 2019

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Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST.

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Section: Penicillin Allergy Interview Assessmentmentioning

confidence: 99%

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

et al. 2019

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“…The “high risk” patient group generally includes recent reactions (< 1 year ago), patients with comorbidities, pregnant women, systemic involvement (encompassing all SCARs) and immediate reactions with angioedema or anaphylaxis. As highlighted in the previously reported studies, the evaluation of direct OPT was performed excluding high-risk patients ( Mill et al, 2016 ; Vezir et al, 2016 ; Iammatteo et al, 2019 ; Kuruvilla et al, 2019 ; Mustafa et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Four subjects were de-labeled based on history. Twenty participants were submitted to OPT, and none developed hypersensitivity reactions ( Kuruvilla et al, 2019 ).…”

Section: How Can We Improve the Diagnosis Of Penicillin Allergy?mentioning

confidence: 99%

Direct Oral Provocation Test Is Safe and Effective in Diagnosing Beta-Lactam Allergy in Low-Risk Children With Mild Cutaneous Reactions

Felix

Kuschnir

2020

Front. Pharmacol.

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“…The investigators reported that all 20 subjects who consented to amoxicillin challenge tolerated the procedure without the development of immediate or delayed hypersensitivity reactions. 9 This study adds to the accumulating body of evidence that supports the safety and efficacy of direct provocative challenge without preliminary skin testing to exclude penicillin allergy in individuals at low risk.…”

mentioning

confidence: 85%

“…On moving to the next group of articles, we focus on penicillin allergy and anaphylaxis. Kuruvilla et al 9 retrospectively evaluated the performance of direct oral amoxicillin challenges without preliminary skin testing in adult patients at low risk and labeled as being allergic to penicillin. The investigators reported that all 20 subjects who consented to amoxicillin challenge tolerated the procedure without the development of immediate or delayed hypersensitivity reactions.…”

mentioning

confidence: 99%