Evaluation of Patients With a History of Penicillin Allergy—Reply

Shenoy, Erica S.; Blumenthal, Kimberly G.

doi:10.1001/jama.2019.4542

Cited by 3 publications

(2 citation statements)

References 6 publications

(9 reference statements)

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“… 22 In contrast, a history-based approach is cost-effective, easy to implement, and does not require a specialized team. 22 – 24 …”

Section: Discussionmentioning

confidence: 99%

“…22 In contrast, a historybased approach is cost-effective, easy to implement, and does not require a specialized team. [22][23][24] Various investigations have explored the precision of a historybased questionnaire for the assessment of antibiotic allergies. [25][26][27] In preoperative contexts, a structured allergy history increased beta-lactam prophylaxis by 277 (57%) cases out of 485 patients, reducing alternative antibiotic use from 81.9% to 55.9%.…”

Section: Discussionmentioning

confidence: 99%

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Assessing the rationale of prescribing carbapenems among hospitalized patients with documented penicillin allergy: implications for stewardship

Burgener-Gasser,

Fasel,

Halbeisen

et al. 2024

ASHE

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Background: A reported history of penicillin allergy frequently leads to the prescription of carbapenems as a substitute for penicillin to avoid allergic reactions. Such self-reported allergies need to be accurately characterized to identify targeted antibiotic stewardship interventions that potentially minimize unnecessary carbapenem use. Design: Retrospective cohort study. Method: The proportion of hospitalized patients with penicillin allergy history receiving carbapenem prescriptions was evaluated between January 1st, 2017 and December 31st, 2018 at the University Hospital Basel, Switzerland. The appropriateness of carbapenem prescription of each patient was evaluated using institutional guidelines based on previously published recommendations. Results: Our analysis revealed that among 212 patients with recorded penicillin allergy, of the 247 carbapenem treatment episodes, 79 (32%) were unjustified. Abdominal and lower respiratory tract infections were most frequently associated with inappropriate carbapenem use (OR 2.64, 95% CI 1.22–5.71, P = .014 and OR 2.26, 95% CI 1.08–4.73, P = .031). The recorded allergy type was not documented or unclear in 153 patients (72%) and penicillin allergy was only confirmed in 2 patients (0.9%). Inconsistencies in allergic symptom documentation and allergy types were found between the institution’s two software programs. Conclusion: While a multimodal approach to identify and accurately label penicillin allergies remains essential to reduce inappropriate carbapenem use, our findings highlight the need for comprehensive and easily accessible guidelines for carbapenem utilization and structured history-based allergy assessment as an initial screening tool, embedded in a tailored digital allergy record template.

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“… 22 In contrast, a history-based approach is cost-effective, easy to implement, and does not require a specialized team. 22 – 24 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessing the rationale of prescribing carbapenems among hospitalized patients with documented penicillin allergy: implications for stewardship

Burgener-Gasser,

Fasel,

Halbeisen

et al. 2024

ASHE

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Update on penicillin allergy delabeling

Shaker

McWilliams

Greenhawt

2020

Current Opinion in Pediatrics

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Purpose of review To review phenotyping and risk classification of penicillin allergy and provide an update on penicillin allergy delabeling strategies for primary care. Recent findings Beta-lactams are considered the treatment of choice for a wide range of bacterial pathogens; however, many patients receive second-line agents due to being labeled as having an allergy to penicillin. This approach can lead to antibiotic resistance and inferior health outcomes. While 10% of the population is labeled as penicillin allergic, penicillin anaphylaxis occurs in less than 1% of patients. For patients with delayed benign skin rashes (e.g., urticaria or maculopapular exanthem >1 h after administration) attributable to beta-lactam administration occurring more than 12 months ago, direct oral challenge (rechallenge with antibiotic in the clinical setting) can be a safe and effective strategy, with immediate reactions occurring in less than 5% of such low-risk patients and delayed reactions appearing infrequently. In patients with penicillin-associated immediate urticaria, other IgE-mediated features, or anaphylaxis, further allergy evaluation and penicillin skin testing is warranted. Any severe idiosyncratic cutaneous adverse reaction is rare, but can be dangerous so prompt removal of the inciting agent is required. Summary Penicillin allergy delabeling is a high-value service that can be effectively delivered through a multidisciplinary collaborative approach.

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A 14-year-old boy with severe erythema multiforme due to amoxicillin

Kurihara,

Yamanishi,

Ozaki

et al. 2023

Asia Pacific Allergy

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The most common cause of erythema multiforme (EM) in children is infectious diseases which account for approximately 90% of cases. Drug eruptions are another common cause. Here we are reporting about a male patient aged 14 years with lymphadenitis who developed severe diffuse erythema during the course of treatment with medications including several antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Based on the pathological findings of the skin biopsy, the skin rash was due to EM. Upon investigating the underlying cause of EM, viral antibody was positive for Coxsackie A6, lymphocyte transformation testing (LTT) was positive for one of the NSAIDs, and the patch test (PT) was positive for amoxicillin. Based on the pattern of distribution of the skin rash, the cause of EM was considered to be drug-induced eruption due to amoxicillin. In this case, we did not derive a diagnosis of drug eruption without investigating the possibility of drug induction, because most cases of EM in children are induced by infection and the antibody against Coxsackie A6 was elevated. To diagnose the possibility of amoxicillin-induced EM, it was important to distinguish between the distribution patterns of infectious versus drug-induced EM and to evaluate the possibility of drug induction by both LTT and PT. If the diagnosis of amoxicillin-induced EM, had not been made, the potential recurrence of EM with amoxicillin could have occurred.

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Evaluation of Patients With a History of Penicillin Allergy—Reply

Cited by 3 publications

References 6 publications

Assessing the rationale of prescribing carbapenems among hospitalized patients with documented penicillin allergy: implications for stewardship

Assessing the rationale of prescribing carbapenems among hospitalized patients with documented penicillin allergy: implications for stewardship

Update on penicillin allergy delabeling

A 14-year-old boy with severe erythema multiforme due to amoxicillin

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