Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy

Park, Miguel; Markus, Patricia J.; Matešić, Damir; Li, James T.C.

doi:10.1016/s1081-1206(10)61100-3

Cited by 125 publications

(87 citation statements)

References 26 publications

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“…Patients with a history of penicillin allergy who have subsequently tolerated a cephalosporin agent generally do not need to undergo penicillin skin testing prior to re-administration of the same cephalosporin drug. The strategy and safety of penicillin skin testing before administration of cephalosporin to patients with a history of penicillin allergy has been validated in several studies [26,27,28,29]. Moreover, we confirm the Joint Task Force on Practice Parameters’ recommendations to proceed with penicillin skin testing in patients with a history of penicillin allergy and needing cephalosporin.…”

Section: Discussionsupporting

confidence: 77%

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Park

Koch

Klemawesch

et al. 2010

Int Arch Allergy Immunol

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Background: Cephalosporin administration in patients with a history of penicillin allergy is controversial. Studies looking at the safety of cephalosporin in patients with a history of penicillin allergy lacked a control group, had a small number of patients, and/or lacked confirmation of penicillin allergy by penicillin skin testing. The purpose of this study was to determine whether patients with penicillin allergy were at increased risk of adverse drug reactions when administered cephalosporin. Methods: A cohort study of patients with a history of penicillin allergy and a positive or negative penicillin skin test when administered cephalosporin was conducted. Charts were reviewed for adverse drug reactions to cephalosporin after penicillin skin testing. Results: Eighty-five patients with a history of penicillin allergy and positive penicillin skin test and 726 patients with a history of penicillin allergy and negative penicillin skin test were administered cephalosporin. Five (6%) of 85 cases had an adverse drug reaction to cephalosporin as compared to 5 (0.7%) of 726 of the referent population (p = 0.0019). The rate of presumed IgE-mediated adverse drug reactions to the cephalosporins amongst the cases was 2 (2%) of 85 compared to 1 (0.1%) of 726 amongst the referent population (p = 0.0304). Conclusion: A greater risk of an adverse drug reaction to cephalosporin exists in patients with penicillin allergy. We recommend penicillin skin testing if cephalosporin, especially a first-generation cephalosporin, is to be administered to patients with a history of penicillin allergy.

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Section: Discussionsupporting

confidence: 77%

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Park

Koch

Klemawesch

et al. 2010

Int Arch Allergy Immunol

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“…Testing is relatively straightforward but undertaken infrequently, potentially resulting in enhanced drug costs due to the prescription of alternative antibiotics especially in patients requiring prophylactic antibiotic treatment for planned procedures [29,30]. In a matched cohort of hospitalized patients, those with a history of penicillin 'allergy' had 0.59 more hospital days during 20 months follow-up compared with controls [31].…”

Section: Epidemiology Of Skin Testingmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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“…In a preoperative assessment clinic, Park et al 49 recruited 1072 patients with a history of BL allergy for penicillin skin testing. Among the 999 patients who underwent the skin test, 43 had a positive skin test for penicillin and three of those 43 eventually received cefazolin.…”

Section: Clinical Reaction To Cephalosporins In Patients With Penicilmentioning

confidence: 99%

“…None developed crossreactivity. 49 Ahmed et al 50 reviewed 173 children with a history of penicillin hypersensitivity, with or without a skin test, who underwent cephalosporin challenge. None among those with positive skin test showed reactivity.…”

Section: Clinical Reaction To Cephalosporins In Patients With Penicilmentioning

confidence: 99%

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

Qu¹

2014

Hong Kong Med J

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A 10% cross-reactivity rate is commonly cited between penicillins and cephalosporins. However, this figure originated from studies in the 1960s and 1970s which included first-generation cephalosporins with similar side-chains to penicillins. Cephalosporins were frequently contaminated by trace amount of penicillins at that time. The sidechain hypothesis for beta-lactam hypersensitivity is supported by abundant scientific evidence. Newer generations of cephalosporins possess side-chains that are dissimilar to those of penicillins, leading to low cross-reactivity. In the assessment of crossreactivity between penicillins and cephalosporins, one has to take into account the background betalactam hypersensitivity, which occurs in up to 10% of patients. Cross-reactivity based on skin testing or in-vitro test occurs in up to 50% and 69% of cases, respectively. Clinical reactivity and drug challenge test suggest an average cross-reactivity rate of only 4.3%. For third-and fourth-generation cephalosporins, the rate is probably less than 1%. Recent international guidelines are in keeping withUse of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited The ten per cent myth about betalactam cross-reactivityPenicillins and cephalosporins are two groups of widely prescribed antibiotics. They belong to the class of beta-lactam (BL) antibiotics because both possess the same BL nucleus. Allergic reactions are common side-effects of BL antibiotics. Studies in the 1960s and 1970s frequently estimated 10% crossreactivity between penicillins and cephalosporins. 1,2 However, at least two recent reviews showed much lower cross-reactivity. 3,4 Notably, cross-reactivity is higher between penicillins and first-and secondgeneration cephalosporins compared with thirdand fourth-generation cephalosporins. 5 The latter two groups are considered safe alternatives for patients with penicillin hypersensitivity. 6 The 10% cross-reactivity rate has recently been questioned as a medical myth. 4,7 Yet until 2005, an influential drug reference such as the British National Formulary (BNF) abided by the "10% rule". 8 Faced with such recommendation, an ordinary physician naturally avoids all BL antibiotics in patients with a history

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Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy

Cited by 125 publications

References 26 publications

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Increased Adverse Drug Reactions to Cephalosporins in Penicillin Allergy Patients with Positive Penicillin Skin Test

Management of allergy to penicillins and other beta‐lactams

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

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