Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children's Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.
CMAJ Open. 2021 Apr 16;9(2):E394-E399. doi: 10.9778/cmajo.20200077. Print 2021 Apr-Jun.
Penicillin is the most frequently reported drug allergen; however, most of these allergies are not true allergies and do not justify the prescription of alternative, less effective and more expensive antibiotic drugs. We aimed to show that patients at low risk of amoxicillin allergy can safely and efficiently undergo oral provocation challenge (OPC) by their primary care physician.
In this descriptive analysis, we conducted a retrospective chart review of all primary care patients who had undergone OPC from November 2017 to October 2019 in the Amoxicillin Allergy Clinic at the North Perth Family Health Team, Listowel, Ontario. Eligibility for OPC among patients 18 months and older was determined through review of a self-reported patient intake form asking about symptoms, onset, duration, history and family history of allergic reactions, as well as the patient's electronic medical record. Patients were considered to be at low risk of true penicillin allergy if there was no history of anaphylaxis or severe cutaneous reactions. Those with low-risk allergic reactions returned for testing with an OPC to amoxicillin. We collected data on clinical characteristics, antibiotic exposure, parental drug allergy, response to OPC and wait time from referral. We used tests to describe and compare these variables. Our primary outcome was reaction to OPC by severity as categorized by the World Allergy Organization grading system. Our secondary outcome was the time from referral to completed testing.
In total, we included 99 patients (mean age 28.3, standard deviation [SD] 21.2 yr); 72 (73%) were female. Of those tested, 97% ( = 96) completed the OPC with no reaction, 3% ( = 3) had mild immediate reactions, and no serious immediate reactions developed. Mean wait time to testing was 59.0 (SD 69.8) days, with a median (interquartile range) of 39.5 (13.5-70.0) days.
Oral provocation challenge presents a safe and accessible opportunity for primary care providers to address erroneous allergy labels to penicillin and related drugs within the primary care office setting. There could be positive public health implications if OPC to penicillin drugs is implemented in primary care.
青霉素是最常报告的药物过敏原；然而，其中大多数过敏并非真正的过敏，并不需要处方替代药物，因为替代药物效果较差且价格更昂贵。我们旨在表明，低阿莫西林过敏风险的患者可以由初级保健医生安全有效地进行口服激发挑战（OPC）。
在这项描述性分析中，我们对 2017 年 11 月至 2019 年 10 月在安大略省列托的北珀斯家庭健康团队的阿莫西林过敏诊所接受 OPC 的所有初级保健患者进行了回顾性图表审查。通过审查一份自我报告的患者摄入表来确定 18 个月及以上患者的 OPC 资格，该表询问了过敏反应的症状、发病、持续时间、病史和家族史，以及患者的电子病历。如果没有过敏反应或严重皮肤反应的病史，则认为患者发生真正的青霉素过敏的风险较低。那些低风险过敏反应的患者接受了阿莫西林 OPC 测试。我们收集了临床特征、抗生素暴露、父母药物过敏、OPC 反应和从转介到完成测试的等待时间等数据。我们使用 检验来描述和比较这些变量。我们的主要结局是根据世界过敏组织分级系统，根据严重程度对 OPC 反应进行分类。我们的次要结局是从转介到完成测试的时间。
总共纳入 99 例患者（平均年龄 28.3 岁，标准差 21.2 岁）；72 例（73%）为女性。在接受测试的患者中，97%（=96）完成了 OPC，没有反应，3%（=3）出现轻度即刻反应，没有出现严重即刻反应。平均等待测试的时间为 59.0 天（标准差 69.8 天），中位数（四分位距）为 39.5 天（13.5-70.0 天）。
口服激发挑战为初级保健提供者提供了一个安全且便捷的机会，可以在初级保健办公室环境中解决青霉素和相关药物的错误过敏标签问题。如果在初级保健中实施青霉素药物的 OPC，可能会产生积极的公共卫生影响。
