Department of Allergy and Immunology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK.
Clin Exp Allergy. 2017 Nov;47(11):1362-1373. doi: 10.1111/cea.13044.
Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications-longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, methicillin-resistant Staphylococcus aureus infections and vancomycin-resistant enterococcus. We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the UK and several other countries and knowledge gaps regarding PenA amongst healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non-specialists rapidly identify and de-label "low-risk" hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost-effectiveness and its compatibility with information technology systems currently employed in the health service.
大约 90-99%被贴上青霉素过敏标签（PenA）的患者经过全面调查后并非真正过敏。不准确的 PenA 标签会对公共健康产生重大影响——住院时间延长、住院次数更频繁、更频繁地使用氟喹诺酮类、糖肽类、头孢菌素类和其他昂贵的抗生素，从而导致医疗服务成本显著增加，并容易导致艰难梭菌、耐甲氧西林金黄色葡萄球菌感染和万古霉素耐药肠球菌感染。我们描述了从最近的研究中了解到的可能导致不准确的 PenA 标签的原因，并提出了一种协同的多学科方法来解决这个重要的公共卫生问题。鉴于英国和其他几个国家对过敏服务的需求未得到满足，以及医疗保健专业人员对 PenA 的了解存在差距，我们描述了计算机化临床决策支持系统的潜在作用，以帮助非专家快速识别和去除“低风险”住院患者的 PenA 标签，从而无需进行过敏测试。然而，这种方法需要进行严格的可行性、安全性、患者和医生可接受性、成本效益以及与医疗服务中当前使用的信息技术系统的兼容性评估。
