Horwitz Simonne L, Shen Ye, Erdle Stephanie C, Elwood Chelsea, Mak Raymond, Jacob John, Wong Tiffany
Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
BC Children's Hospital Research Institute, Vancouver, BC, Canada.
World Allergy Organ J. 2024 Jul 23;17(8):100939. doi: 10.1016/j.waojou.2024.100939. eCollection 2024 Aug.
Penicillin allergy is reported in 10% of the population; however, over 90% of patients are deemed non-allergic upon allergist assessment. The goal of this quality improvement project is to validate a patient-driven assessment tool to safely identify patients at low risk of penicillin allergy and de-label them. Pediatric patients and pregnant women referred to the institution's allergy clinics for penicillin allergy assessment were invited to use the patient tool to complete a self-assessment, resulting in the assignment of a risk category. The risk stratification determined using the patient tool was compared against the allergist's assessment. The patient tool demonstrated agreement with the allergist assessment in 57/84 (67.9%, 95% CI [56.7%,77.4%]) assessments, intra-class correlation (ICC) = 0.618, p < 0.001. In 22/84 (26.2%) assessments, the patient tool determined a higher risk category, primarily due to differences in patients' perceived timing and description of symptoms. Only 5/84 (6.0%) patients were placed in a lower risk category by the patient tool compared to the allergist assessment. The patient tool demonstrates good validity in determining penicillin allergy risk, offering potential as a method of empowering patients to advocate in their care. Iterative changes to the patient tool will be applied to increase agreement.
据报告，10%的人群对青霉素过敏；然而，经过敏症专科医生评估，超过90%的患者被认为无过敏反应。本质量改进项目的目标是验证一种由患者驱动的评估工具，以安全地识别青霉素过敏低风险患者并去除其过敏标签。被转诊至该机构过敏诊所进行青霉素过敏评估的儿科患者和孕妇被邀请使用患者工具完成自我评估，从而确定风险类别。将使用患者工具确定的风险分层与过敏症专科医生的评估结果进行比较。在84次评估中的57次（67.9%，95%可信区间[56.7%，77.4%]）中，患者工具与过敏症专科医生的评估结果一致，组内相关系数（ICC）=0.618，p<0.001。在84次评估中的22次（26.2%）中，患者工具确定的风险类别更高，主要是由于患者对症状出现时间和描述的认知存在差异。与过敏症专科医生的评估相比，患者工具仅将84名患者中的5名（6.0%）归为较低风险类别。患者工具在确定青霉素过敏风险方面显示出良好的有效性，具有让患者在其医疗护理中发挥自主作用的潜力。将对患者工具进行迭代修改以提高一致性。
