Livirya Silabhakta, Pithie Alan, Chua Ignatius, Hamilton Niall, Doogue Matthew, Isenman Heather
General Medicine, Hawke's Bay Hospital, Hastings, New Zealand.
Department of Infectious Diseases, General Medicine, Christchurch Hospital, Christchurch, New Zealand.
Intern Med J. 2022 Feb;52(2):295-300. doi: 10.1111/imj.14978. Epub 2022 Jan 12.
Penicillin allergy is the most reported adverse drug reaction (ADR). Being labelled with 'penicillin allergy' is associated with suboptimal antibiotic therapy and poor patient outcomes. Most labelled with 'penicillin allergy' are at low risk of harm from penicillins and guidelines recommend testing for accurate diagnosis. Although skin testing is recommended to exclude immunoglobulin E (IgE)-mediated reactions, there is limited access in most settings.
To evaluate oral amoxicillin challenge without prior skin testing for patients labelled with 'penicillin allergy' assessed as low risk during hospital admission.
General Medical inpatients with a 'penicillin allergy' label were assessed. For those who had tolerated a penicillin since the index event, the ADR label was removed. Those assessed as 'low risk' were administered 250 mg amoxicillin orally without prior skin testing. The durability of de-labelling was subsequently assessed by review of clinical records.
Of 224 patients with a history of a penicillin ADR, 162 (72%) were low risk. A further 12 were excluded and of the remaining 150, 56 (37%) had tolerated penicillins since their index reaction and were de-labelled without challenge, 15 (10%) with a non-allergic history were de-labelled. The remaining 79 were offered an oral amoxicillin challenge; 38 declined and 41 tolerated amoxicillin. Overall, 112 of the 224 (50%) patients had their ADR label removed.
A careful ADR history enables de-labelling of many patients. An oral amoxicillin challenge without prior skin testing is safe and feasible for low-risk penicillin allergic patients while in hospital.
青霉素过敏是报告最多的药物不良反应（ADR）。被标记为“青霉素过敏”与抗生素治疗欠佳及患者预后不良相关。大多数被标记为“青霉素过敏”的患者使用青霉素产生危害的风险较低，指南建议进行检测以准确诊断。尽管推荐进行皮肤试验以排除免疫球蛋白E（IgE）介导的反应，但在大多数情况下难以进行。
评估在住院期间被评估为低风险的、标记有“青霉素过敏”的患者在不进行预先皮肤试验的情况下口服阿莫西林激发试验的效果。
对标记有“青霉素过敏”的普通内科住院患者进行评估。对于自索引事件以来耐受青霉素的患者，去除ADR标记。对被评估为“低风险”的患者在不进行预先皮肤试验的情况下口服250mg阿莫西林。随后通过查阅临床记录评估去除标记的持久性。
在224例有青霉素ADR病史的患者中，162例（72%）为低风险。另有12例被排除，在其余150例中，56例（37%）自索引反应以来耐受青霉素，未经激发试验即去除标记，15例（10%）无过敏史的患者被去除标记。其余79例接受口服阿莫西林激发试验；38例拒绝，41例耐受阿莫西林。总体而言，224例患者中有112例（50%）的ADR标记被去除。
仔细询问ADR病史可使许多患者去除标记。对于住院期间低风险的青霉素过敏患者，不进行预先皮肤试验进行口服阿莫西林激发试验是安全可行的。
