a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France.
b Immunology and Infectious diseases Center - Paris (Cimi-Paris) , Sorbonne University , Paris , France.
Ann Med. 2017 Dec;49(8):710-717. doi: 10.1080/07853890.2017.1370125. Epub 2017 Aug 26.
About 10% of subjects report suspected penicillin allergy, but 85-90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics Objective: To design and validate a clinical decision-making algorithm, based on anamnesis (chronology, severity, and duration of the suspected allergic reactions) and reaching a 100% sensitivity and negative predictive value, to assess allergy risk related to a penicillin prescription in general practise.
All patients were included prospectively and explorated based on ENDA/EAACI recommendations. Results of penicillin allergy work-up (gold standard) were compared with results of the algorithm.
Allergological work-up diagnosed penicillin hypersensitivity in 41/259 patients (15.8%) [95% CI: 11.5-20.3]. Three of these patients were diagnosed as having immediate-type hypersensitivity to penicillin, but had been misdiagnosed as low risk patients using the clinical algorithm. Thus, the sensitivity and negative predictive value of the algorithm were 92.7% [95% CI: 80.1-98.5] and 96.3% [95% CI: 89.6-99.2], respectively, and the probability that a patient with true penicillin allergy had been misclassified was 3.7% [95% CI: 0.8-10.4].
Although the risk of misclassification is low, we cannot recommend the use of this algorithm in general practice. However, the algorithm can be useful in emergency situations in hospital settings. Key messages True penicillin allergy is considerably lower than alleged penicillin allergy (15.8%; 41 of the 259 patients with suspected penicillin allergy). A clinical algorithm based on the patient's clinical history of the supposed allergic event to penicillin misclassified 3/41 (3.7%) truly allergic patients.
约 10%的受试者报告疑似青霉素过敏，但其中 85-90%的患者并非真正过敏，并且可以安全使用β-内酰胺类抗生素。目的：设计并验证一种临床决策算法，基于病史（疑似过敏反应的时间、严重程度和持续时间），以达到 100%的敏感性和阴性预测值，从而评估一般实践中开具青霉素处方的过敏风险。
所有患者均前瞻性纳入并根据 ENDA/EAACI 建议进行探索。青霉素过敏检测结果（金标准）与算法结果进行比较。
过敏检测诊断 41/259 例患者（15.8%）[95%CI：11.5-20.3]对青霉素过敏。其中 3 例患者被诊断为对青霉素具有即刻型过敏反应，但使用临床算法将其误诊为低风险患者。因此，该算法的敏感性和阴性预测值分别为 92.7%[95%CI：80.1-98.5]和 96.3%[95%CI：89.6-99.2]，真正对青霉素过敏的患者被误诊的概率为 3.7%[95%CI：0.8-10.4]。
虽然误诊的风险较低，但我们不能推荐在一般实践中使用该算法。然而，该算法在医院环境中的紧急情况下可能会有用。主要信息真正的青霉素过敏明显低于疑似青霉素过敏（15.8%；259 例疑似青霉素过敏的患者中有 41 例）。基于疑似青霉素过敏事件的患者临床病史的临床算法误诊了 3/41（3.7%）真正过敏的患者。
