Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
Allergy. 2020 Feb;75(2):273-288. doi: 10.1111/all.13848. Epub 2019 May 26.
Even though 8%-25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de-labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus.
We performed an evidence-based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de-labeling. Over the period 1928-2018 in Pubmed and Medline, search terms used included "penicillin allergy" or "penicillin hypersensitivity" alone or in combination with "adverse events," "testing," "evaluation," "effects," "label," "de-labeling," "prick or epicutaneous," and "intradermal" skin testing, "oral challenge or provocation," "cross-reactivity," and "antimicrobial stewardship".
Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance.
Operationalizing penicillin allergy de-labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de-labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.
尽管全球大多数人群中有 8%-25%被标记为青霉素过敏，但大多数青霉素过敏的诊断是在儿童时期做出的，这些诊断与非过敏性质的事件、发生即刻过敏反应的风险较低的事件或随时间推移而减弱的潜在真正过敏有关。青霉素过敏标签直接影响抗菌药物管理，导致使用效果较差且广谱的抗菌药物，并与抗菌药物耐药性有关。它们还可能延迟适当的抗菌药物治疗，并导致特定不良医疗保健结果的风险增加。将青霉素过敏去标签化作为抗菌药物管理计划 (ASP) 的新分支实施已成为全球日益关注的焦点。
我们对青霉素过敏标签携带、青霉素过敏标签的不良影响以及当前青霉素过敏去标签化方法和障碍的文献进行了循证叙述性综述。在 1928 年至 2018 年期间，在 Pubmed 和 Medline 中使用的搜索词包括“青霉素过敏”或“青霉素过敏反应”单独或与“不良事件”、“测试”、“评估”、“影响”、“标签”、“去标签化”、“皮内或皮试”、“皮下”皮肤测试、“口服挑战或激发”、“交叉反应”和“抗菌药物管理”组合使用。
青霉素过敏标签非常普遍，主要是不准确的，其携带可能导致不必要的治疗和使用替代药物的不良结果，以及抗生素耐药等不良公共卫生后果。
将青霉素过敏去标签化作为 ASP 的一个方面实施已成为全球日益关注的焦点。需要有经过验证的方法，这些方法最好结合使用病史和摄入挑战，无论是否进行正式皮肤测试，以在复杂的医疗保健系统中有效地处理青霉素过敏问题。同时，青霉素过敏评估和去标签化作为减少不良医疗保健结果、改善抗菌药物管理和降低医疗保健成本的个人和公共卫生策略具有很大的潜力。
