Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA.
Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA.
Int Forum Allergy Rhinol. 2023 Jun;13(6):973-978. doi: 10.1002/alr.23173. Epub 2023 May 9.
A patient-reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin-E (IgE)-mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs. As physicians who treat patients of all ages for common sinonasal pathology in the clinic and operating room in addition to frequently providing testing and management of allergic diseases, rhinologists are well positioned to aid in delabeling patients with inaccurate penicillin allergies. This viewpoint highlights the consequences of inaccurate penicillin allergy designation in the clinic and perioperative period and explores misconceptions regarding cross-reactivity between penicillins and cephalosporins. Opportunities are explored for shared decision-making with colleagues in other specialties, such as anesthesiology, and practical recommendations are provided to aid rhinologists when faced with a patient who holds a questionable history of penicillin allergy. Rhinologists can play an active role in delabeling patients with inaccurate penicillin allergies with the goal of ensuring appropriate antibiotic use for future medical encounters.
患者自述青霉素过敏史是一种常见现象，其发生率约为 10%。然而，多达 95%报告青霉素过敏的患者并没有真正的免疫球蛋白 E（IgE）介导的过敏反应。不幸的是，青霉素过敏错误标签是一个问题，导致抗生素使用不当，并产生不良后果，如药物不良反应、治疗效果不佳和增加成本。由于鼻科医生在诊所和手术室治疗各种年龄段的常见鼻-鼻窦疾病患者，并且经常进行过敏疾病的检测和管理，因此他们非常适合帮助那些对青霉素过敏不准确的患者解除过敏标签。本观点强调了在临床和围手术期不准确的青霉素过敏指定的后果，并探讨了青霉素和头孢菌素之间交叉反应的误解。还探讨了与麻醉科等其他专业的同事共同决策的机会，并为鼻科医生在面对持有可疑青霉素过敏史的患者时提供了实用建议。鼻科医生可以在解除不准确的青霉素过敏患者的过敏标签方面发挥积极作用，以确保在未来的医疗接触中使用适当的抗生素。
