Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
J Allergy Clin Immunol Pract. 2019 Jan;7(1):251-258. doi: 10.1016/j.jaip.2018.05.025. Epub 2018 Jun 5.
A spurious label of penicillin allergy (Pen-A) negatively impacts on antibiotic stewardship and health care costs. Recent studies have proposed a guideline-steered direct penicillin challenge without undertaking allergy tests when "true allergy" is unlikely.
To critically analyze Pen-A clinical presentation, perform risk stratification, and determine clinical predictors for "true allergy."
Data were extracted retrospectively from clinical and electronic patient records.
A total of 231 patients (M = 82; F =149; mean age 51.22 [standard deviation ± 18.07] years) were analyzed. Based on clinical history, patients were categorized as likely type I hypersensitivity reaction (HSR) (n = 27), likely type IV HSR (n = 65), indeterminate (n = 111), and HSR unlikely (n = 28). Based on an index reaction and comorbidities, patients were classified into "low risk" (n = 143) and "high risk" (n = 78). Pen-A was excluded in 74% of patients assessed having likely type I HSR, 91% with likely type IV HSR, 93% of indeterminate, and 100% of HSR unlikely patients. The negative predictive value for successful delabeling in the "low risk" group was 94% (odds ratio [OR] = 2.9; P = .02). Predictors for "true Pen-A" were history of anaphylaxis (OR = 30.6; P < .001), hospitalization (OR = 7; P < .001), ≤5 years since the index reaction (OR = 3; P = .04).
Systematic clinical characterization and risk stratification has an important role in Pen-A delabeling. These data provide proof of concept for a guideline-based selection of patients labeled with Pen-A for a direct penicillin challenge. Patients in the "low risk" group seem suitable for this intervention, although a rigorous prospective evaluation is needed in a multicenter study.
青霉素过敏（Pen-A）的错误标签会对抗生素管理和医疗保健成本产生负面影响。最近的研究提出了一种指南指导的直接青霉素挑战，当“真正的过敏”不太可能时，无需进行过敏测试。
批判性分析 Pen-A 的临床表现，进行风险分层，并确定“真正过敏”的临床预测因素。
数据从临床和电子患者记录中回顾性提取。
共分析了 231 名患者（M=82；F=149；平均年龄 51.22[标准差±18.07]岁）。根据临床病史，患者分为可能为 I 型超敏反应（HSR）（n=27）、可能为 IV 型 HSR（n=65）、不确定（n=111）和 HSR 不太可能（n=28）。根据指数反应和合并症，患者分为“低风险”（n=143）和“高风险”（n=78）。在评估有 I 型 HSR 可能的患者中，74%排除了 Pen-A，91%有 IV 型 HSR 可能的患者，93%不确定的患者和 100% HSR 不太可能的患者。在“低风险”组中，成功去除标签的阴性预测值为 94%（比值比[OR]为 2.9；P=0.02）。“真正的 Pen-A”的预测因素是过敏反应史（OR=30.6；P<0.001）、住院治疗（OR=7；P<0.001）和从指数反应开始≤5 年（OR=3；P=0.04）。
系统的临床特征和风险分层在去除 Pen-A 标签方面具有重要作用。这些数据为基于指南选择被标记为 Pen-A 的患者进行直接青霉素挑战提供了概念验证。“低风险”组的患者似乎适合这种干预，尽管需要在多中心研究中进行严格的前瞻性评估。
