Dore Michael, Otto Ashley, Wang Annie, Heintz Carly, Cantrell Sarah, Shields Daniel, Burkhart Allyson
Duke University School of Medicine, Durham, NC, USA.
Durham Veteran's Affairs Medical Center, Durham, NC, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Jul 31;5(1):e167. doi: 10.1017/ash.2025.10080. eCollection 2025.
Penicillin allergies are reported in 10-15% of the US population, but the actual rate is less than 1%. Inappropriate penicillin allergies are associated with adverse patient outcomes, poor antimicrobial stewardship, and increased healthcare costs. Direct oral provocation testing (DOPT) is a safe and cost-effective way to remove false penicillin allergy labels (PAL). However, widespread implementation is currently limited due to inadequate safety data and protocol variations. This systematic review evaluates the safety of single-dose, nongraded DOPT by the nonallergist.
Systematic review. MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to May 2025.
Inpatient (Intensive care unit (ICU) and general medical ward) and outpatient.
Adults with self-reported penicillin allergies deemed low risk by a validated scoring system.
DOPT by nonallergists with single-dose oral amoxicillin 250 mg with a 60-minute observation period.
3 352 studies were identified, 15 were included in the analysis. Of the 1786 patients who completed DOPT, 66 (3.7%) experienced any reaction: 27 (1.5%) immediate rashes, 24 (1.3%) delayed rashes, and 15 (.8%) other reactions. No cases of anaphylaxis, angioedema, or epinephrine use were reported.
The use of single-dose DOPT in patients deemed low risk, using a validated risk scoring tool, is safe, with low rates of mild reactions and no serious adverse events. A nonallergist can significantly improve penicillin delabeling rates and patient outcomes using this approach.
据报告，美国有10% - 15%的人口对青霉素过敏，但实际发生率低于1%。不恰当的青霉素过敏诊断与不良的患者预后、抗菌药物管理不善以及医疗成本增加有关。直接口服激发试验（DOPT）是一种安全且具有成本效益的方法，可去除错误的青霉素过敏标签（PAL）。然而，由于安全数据不足和方案差异，目前其广泛应用受到限制。本系统评价评估了非过敏专科医生进行单剂量、非分级DOPT的安全性。
系统评价。检索了MEDLINE、Embase、Web of Science和Cochrane对照试验中央注册库，检索时间从建库至2025年5月。
住院患者（重症监护病房（ICU）和普通内科病房）和门诊患者。
经有效评分系统判定为低风险的自我报告对青霉素过敏的成年人。
非过敏专科医生进行DOPT，口服单剂量250mg阿莫西林，并观察60分钟。
共识别出3352项研究，15项纳入分析。在1786例完成DOPT的患者中，66例（3.7%）出现任何反应：27例（1.5%）出现即刻皮疹，24例（1.3%）出现延迟皮疹，15例（0.8%）出现其他反应。未报告过敏反应、血管性水肿或使用肾上腺素的病例。
使用经过验证的风险评分工具，对低风险患者采用单剂量DOPT是安全的，轻度反应发生率低，且无严重不良事件。非过敏专科医生采用这种方法可显著提高青霉素脱敏率和患者预后。
