The challenge of de‐labeling penicillin allergy
Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy...
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| Vydáno v: | Allergy (Copenhagen) Ročník 75; číslo 2; s. 273 - 288 |
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| Hlavní autoři: | , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
Denmark
Blackwell Publishing Ltd
01.02.2020
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| Témata: | |
| ISSN: | 0105-4538, 1398-9995, 1398-9995 |
| On-line přístup: | Získat plný text |
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| Shrnutí: | Background
Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus.
Methods
We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”.
Results
Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance.
Conclusions
Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs. |
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| Bibliografie: | Funding information Dr. Stone receives funding from 5T32 GM007569‐41 from NIH/NIGMS. Dr. Phillips receives funding related to this project from: National Institutes of Health (1P50GM115305‐01, 1P30AI110527‐01A1, R21AI139021 and R34AI136815), National Health and Medical Research (NHMRC) Foundation of Australia. Dr. Trubiano is supported by an NHMRC Early Career Fellowship and funding from The National Centre for Infections in Cancer and Austin Medical Research Foundation. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23 CAS, JT, DTC, CRFR, and EJP have all contributed to the manuscript during conceptualization, review of the literature, drafting, editing, and revising the final manuscript. This manuscript has been approved by all the authors. Statement of Author Contributions |
| ISSN: | 0105-4538 1398-9995 1398-9995 |
| DOI: | 10.1111/all.13848 |