Roberts Hannah, Soller Lianne, Ng Karen, Chan Edmond S, Roberts Ashley, Kang Kristopher, Hildebrand Kyla J, Wong Tiffany
Division of Allergy and Immunology, Department of Medicine, Western University, St. Joseph's Health Care, 268 Grosvenor St, London, ON, N6A 3N3, Canada.
Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Allergy Asthma Clin Immunol. 2020 Dec 4;16(1):103. doi: 10.1186/s13223-020-00501-6.
Beta-lactam allergy is reported in 5-10% of children in North America, but up to 94-97% of patients are deemed not allergic after allergist assessment. The utility of standardized skin testing for penicillin allergy in the pediatric population has been recently questioned. Oral drug challenges when appropriate, are preferred over skin testing, and can definitively rule out immediate, IgE-mediated drug allergy. To our knowledge, this is the only pediatric study to assess the reliability of a penicillin allergy stratification tool using a paper and electronic clinical algorithm. By using an electronic algorithm, we identified 61 patients (of 95 deemed not allergic by gold standard allergist decision) as low risk for penicillin allergy, with no false negatives and without the need for allergist assessment or skin testing. In this study, we demonstrate that an electronic algorithm can be used by various pediatric clinicians when evaluating possible penicillin allergy to reliably identify low risk patients. We identified the electronic algorithm was superior to the paper version, capturing an even higher percentage of low risk patients than the paper version. By developing an electronic algorithm to accurately assess penicillin allergy risk based on appropriate history, without the need for diagnostic testing or allergist assessment, we can empower non-allergist health care professionals to safely de-label low risk pediatric patients and assist in alleviating subspecialty wait times for penicillin allergy assessment.
据报道，北美有5%至10%的儿童对β-内酰胺类药物过敏，但在经过过敏症专科医生评估后，高达94%至97%的患者被认为没有过敏。儿科人群中青霉素过敏标准化皮肤试验的效用最近受到质疑。在适当的时候，口服药物激发试验比皮肤试验更可取，并且可以明确排除速发型、IgE介导的药物过敏。据我们所知，这是唯一一项使用纸质和电子临床算法评估青霉素过敏分层工具可靠性的儿科研究。通过使用电子算法，我们确定了61名患者（在95名经金标准过敏症专科医生判定无过敏的患者中）青霉素过敏风险较低，没有假阴性结果，也无需过敏症专科医生评估或皮肤试验。在本研究中，我们证明了在评估可能的青霉素过敏时，各种儿科临床医生可以使用电子算法可靠地识别低风险患者。我们发现电子算法优于纸质版本，识别出的低风险患者比例甚至高于纸质版本。通过开发一种基于适当病史准确评估青霉素过敏风险的电子算法，无需诊断测试或过敏症专科医生评估，我们可以使非过敏症专科的医疗保健专业人员有能力安全地去除低风险儿科患者的过敏标签，并有助于减少青霉素过敏评估的专科等待时间。
