Treatment of Patients with a History of Penicillin Allergy in a Large Tertiary-Care Academic Hospital

Picard, Matthieu; Bégin, Philippe; Bouchard, Hugues; Cloutier, Jonathan; Lacombe-Barrios, Jonathan; Paradis, Jean; Roches, Anne Des; Laufer, Brian; Paradis, Louis

doi:10.1016/j.jaip.2013.01.006

Cited by 165 publications

(120 citation statements)

References 34 publications

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“…4 A systematic review performed in 2009 by Lee et al 5 examined 5 trials assessing the use of acupuncture in the management of SAR and found that the results "fail to show specific effects of acupuncture" compared with SA. The results of this current study are similar to the results of Williamson et al 6 and the 2002 study by Xue et al 3 A more recent randomized, single-blinded, crossover study by Brinkhaus et al 7 in 2013 examined QoL and RM scores in 422 patients with SAR who received RA, SA, or RM alone and found a statistically significant improvement in QoL and antihistamine use in RA. However, owing to study limitations, the investigators admitted that such findings…”

Section: Roland Solensky MDsupporting

confidence: 88%

“…Antibiotic costs (in both outpatient and inpatient settings) have been reported to be higher in patients with a history of penicillin allergy compared with patients without a history of penicillin allergy. 3,4 In the aforementioned study by Macy et al, inpatients considered to be penicillin allergic were hospitalized 0.59 days longer than matched controls, which translated to an additional cost of $64.6 million. 2 Penicillin allergy evaluation, which usually results in negative penicillin skin test results, decreases antibiotic costs.…”

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confidence: 99%

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A novel approach to improving antibiotic selection in patients reporting penicillin allergy

Solensky¹

2015

Annals of Allergy, Asthma & Immunology

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Section: Roland Solensky MDsupporting

confidence: 88%

mentioning

confidence: 99%

A novel approach to improving antibiotic selection in patients reporting penicillin allergy

Solensky¹

2015

Annals of Allergy, Asthma & Immunology

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“…In addition to worse clinical outcomes, potentially unnecessary avoidance of BL antibiotics has been shown to increase health care costs for the patient and hospital. A study by Picard et al 29 found that patients identified as having a penicillin allergy carried an additional cost of more than $15,000 because of the use of alternative NBL antibiotics. As evidenced by Li et al, 30 NBL costs can be 1.82-to 2.58-fold higher compared with first-line antibiotics when used in patients with a penicillin allergy.…”

Section: Discussionmentioning

confidence: 99%

Consequences of avoiding β-lactams in patients with β-lactam allergies

Jeffres

Narayanan

Shuster

et al. 2016

Journal of Allergy and Clinical Immunology

130

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“…Allergy evaluation should also be stressed as an economical decision; a recent study in the setting of selected inpatient wards estimated that the avoidance of ␤-lactam antibiotics on only 55 occasions incurred an additional cost of $15,672 (Canadian dollars). 20 Overall, penicillin testing and challenge is a well-tolerated, effective service that should be offered in an elective manner before patients are in a critical condition requiring specific antibiotic regimens.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

Albin

Agarwal²

2014

allergy asthma proc

136

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Penicillin P enicillin allergy remains the most common drug allergy reported, with a prevalence of ϳ8 -12% depending on the specific population evaluated. 1-3Higher rates are noted in individuals receiving more health care, including female patients and with increasing age.2,3 Symptoms associated with reported penicillin allergy classically include rash and/or itching, nausea, vomiting, shortness of breath, and anaphylaxis. However, often reported symptoms are either classified as unknown or representative of non-IgE-mediated reactions, such as nonurticarial rashes resulting from underlying viral illnesses. 4 The Choosing Wisely campaign recommends appropriate evaluation of patients with a history of penicillin allergy rather than avoidance or use of alternative antibiotics that can increase medical costs, patient morbidity, and potentially contribute to further antibiotic resistance.5,6 After a complete evaluation, up to 90% of individuals with a history of penicillin allergy are able to tolerate penicillins.1 Despite these favorable statistics, drug allergies are very rarely confirmed or removed from the medical record, and penicillin allergy is overdiagnosed with the antibiotic class avoided as part of a "safe rather than sorry" approach. 2,4,7 It is therefore important to study the epidemiology of penicillin allergy, because it may help practitioners better identify the patients at risk for true drug allergy. Relatively few studies have examined the characteristics of penicillin allergy in various patient populations. A 20-year retrospective study published by Ponvert et al. is the largest to report on ␤-lactam allergy in children. They showed that a history of severe skin symptoms such as acute generalized Stevens-Johnson Syndrome (SJS), serum sickness-like reactions, and anaphylaxis were risk factors for ␤-lactam allergy, although age, gender, and a history of atopy were not contributing factors. 8 In contrast, the largest retrospective study of both children and adults with self-reported antibiotic allergy by Macy et al. found that female gender and older age were associated with a higher rate of self-reported allergy, albeit without confirmation by skin and challenge testing.2 Despite these reports, there are still few published data on the epidemiology of penicillin allergy in the outpatient population of the United States.

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Treatment of Patients with a History of Penicillin Allergy in a Large Tertiary-Care Academic Hospital

Cited by 165 publications

References 34 publications

A novel approach to improving antibiotic selection in patients reporting penicillin allergy

A novel approach to improving antibiotic selection in patients reporting penicillin allergy

Consequences of avoiding β-lactams in patients with β-lactam allergies

Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population

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