Institute of Immunology and Immunotherapy, University of Birmingham and Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Pharmacy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
J Infect. 2024 Mar;88(3):106116. doi: 10.1016/j.jinf.2024.01.015. Epub 2024 Feb 6.
The huge burden of inaccurate penicillin allergy labels (PALs) is an important driver of antimicrobial resistance. This is magnified by insufficient allergy specialists and lack of 'point-of-care' tests. We investigated the feasibility of non-allergy healthcare professionals (HCPs) delivering direct oral penicillin challenges (DPCs) for penicillin allergy de-labelling.
This prospective observational study was conducted in three hospitals in England across three settings (acute medical, pre-surgical and haematology-oncology). Patients with a PAL were screened and stratified as low risk/high risk. Low risk patients (non-immune mediated symptoms, benign rash, tolerated amoxicillin since and family history) underwent a DPC.
N = 2257 PALs were screened, 1054 were eligible; 643 were approached, 373 declined, 270 consented and 259 risk stratified (low risk = 155; high risk = 104). One hundred and twenty-six low risk patients underwent DPC, 122 (96.8%) were de-labelled with no serious allergic reactions. Conversion rate from screening-to-consent was 12% [3.3% and 17.9% in acute and elective settings respectively; odds ratios for consent were 3.42 (p < 0.001) and 5.53 (p < 0.001) in haematology-oncology and pre-surgical setting respectively. Common reasons for failure to progress in the study included difficulty in reaching patients, clinical instability/medical reasons, lacking capacity to consent and psychological factors.
DPCs can be delivered by non-allergy HCPs. A high proportion of patients with PALs did not progress in the study pathway. Strategies to deliver DPC at optimal points of the care pathway are needed to enhance uptake. Elective settings offer greater opportunities than acute settings for DPC. The safety and simplicity of DPCs lends itself to adoption by healthcare systems beyond the UK, including in resource-limited settings.
不准确的青霉素过敏标签（PAL）带来了巨大负担，是导致抗生素耐药性的一个重要因素。过敏专家不足和缺乏“即时检测”进一步加剧了这一问题。我们研究了非过敏专业医护人员（HCP）进行直接口服青霉素挑战（DPC）以去除青霉素过敏标签的可行性。
这项前瞻性观察研究在英格兰的三家医院的三个科室（急性内科、术前和血液肿瘤科）进行。对有 PAL 的患者进行筛选和分层，分为低风险/高风险。低风险患者（非免疫介导的症状、良性皮疹、自服阿莫西林且有家族史）进行 DPC。
共筛选了 2257 例 PAL，其中 1054 例符合条件；共接触了 643 例，373 例拒绝，270 例同意，259 例进行了风险分层（低风险 155 例，高风险 104 例）。126 例低风险患者进行了 DPC，122 例（96.8%）被去标签化，无严重过敏反应。从筛选到同意的转化率为 12%[分别为急性科室和择期科室的 3.3%和 17.9%；血液肿瘤科和术前科室同意的比值比分别为 3.42（p<0.001）和 5.53（p<0.001）]。研究中未能进展的常见原因包括难以联系到患者、临床不稳定/医学原因、缺乏同意能力和心理因素。
DPC 可由非过敏 HCP 进行。很大一部分有 PAL 的患者无法在研究途径中进展。需要在最佳护理路径点提供 DPC 策略以提高参与度。择期科室比急性科室提供了更多进行 DPC 的机会。DPC 的安全性和简单性使其适合英国以外的医疗系统采用，包括资源有限的环境。
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