护士主导、基于方案的青霉素过敏评估的有效性、安全性和真实世界结局比较：来自香港药物过敏去标签倡议（HK-DADI）。

Comparative Effectiveness, Safety, and Real-World Outcomes of a Nurse-Led, Protocol-Driven Penicillin Allergy Evaluation From the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI).

机构信息

Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.

Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong.

出版信息

J Allergy Clin Immunol Pract. 2023 Feb;11(2):474-480.e2. doi: 10.1016/j.jaip.2022.08.052. Epub 2022 Sep 17.

DOI:10.1016/j.jaip.2022.08.052

PMID:36126867

Abstract

BACKGROUND

There is a high prevalence of unconfirmed penicillin allergy, which is associated with a multitude of adverse clinical outcomes. With the overwhelming burden of currently incorrect labels and the lack of allergy specialist services, new delabeling strategies are urgently needed.

OBJECTIVE

To assess the effectiveness, safety, and real-world outcomes of a nurse-led, protocol-driven evaluation of penicillin allergy, the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI).

METHODS

Adult patients with suspected penicillin allergy were recruited into HK-DADI. Allergy and postdelabeling outcomes were retrospectively compared between patients evaluated via HK-DADI or traditional allergist evaluation.

RESULTS

A total of 312 completed penicillin allergy evaluation: 84 (27%) and 228 (73%) via HK-DADI and traditional pathways, respectively. Overall, 280 penicillin allergies were delabeled (90%). The delabeling rate between HK-DADI and traditional pathways was similar (90% vs 89%; P = .796). Among patients of the HK-DADI pathway, the delabeling rate was significantly higher among low-risk (LR) compared with non-LR patients (97% vs 77%; P = .010). Skin tests did not add diagnostic value among LR patients. No patients developed severe or systemic reactions during the evaluation. Upon 6- to 12-month follow-up (median, 10 months), 123 patients experienced infective episodes (44%) and 63 used penicillins again after delabeling (23%). This proportion was significantly higher in patients who were delabeled via HK-DADI compared with the traditional pathway (32% vs 19%; P = .026).

CONCLUSIONS

The Hong Kong Drug Allergy Delabelling Initiative, a nurse-led, protocol-driven evaluation, was safe and effective in penicillin allergy delabeling. It led to an even higher rate of future penicillin use after delabeling and mitigated the need for unnecessary skin testing among LR patients.

摘要

背景

青霉素过敏未经确认的情况较为普遍，而这种情况与众多不良临床结局相关。目前，错误标签泛滥且缺乏过敏专科医生，因此急需新的去标签策略。

目的

评估以护士为主导、基于方案的青霉素过敏评估（香港药物过敏去标签计划，即 HK-DADI）在有效性、安全性和真实世界结局方面的表现。

方法

招募疑似青霉素过敏的成年患者入组 HK-DADI。回顾性比较经 HK-DADI 或传统过敏医生评估的患者的过敏和去标签后结局。

结果

共完成 312 例青霉素过敏评估：84 例（27%）和 228 例（73%）分别通过 HK-DADI 和传统途径进行。总体而言，280 例（90%）青霉素过敏被去标签。HK-DADI 和传统途径的去标签率相似（90%比 89%；P=.796）。在 HK-DADI 途径的患者中，低风险（LR）患者的去标签率显著高于非 LR 患者（97%比 77%；P=.010）。皮肤试验在 LR 患者中并未增加诊断价值。在评估过程中，没有患者发生严重或全身性反应。在 6 至 12 个月的随访（中位数 10 个月）中，123 例患者发生感染发作（44%），63 例（23%）去标签后再次使用青霉素。通过 HK-DADI 去标签的患者的这一比例显著高于通过传统途径去标签的患者（32%比 19%；P=.026）。