Testing low risk penicillin allergic hospital patients with a single dose of oral amoxicillin

None listed

Penicillin allergy is reported by between 10 and 20% of hospital inpatients, However, fewer than 10% of these patients have allergy confirmed on formal testing. Being labelled as penicillin allergic carries a substantial burden. There is increased length of stay, cost, and adverse outcomes associated with penicillin allergy, a need for alternative antimicrobial agents, and potential for treatment failure and readmission. Accordingly, the recent Infectious Diseases Society of America (IDSA) antimicrobial stewardship guidelines recommend reviewing patient’s antibiotic allergy status as an integral stewardship intervention. An immediate hypersensitivity or IgE mediated reaction is normally excluded by skin testing, followed by an oral challenge, as recommended by the Australasian Society of Clinical Immunology and Allergy (ASCIA). Skin testing requires: (i) specific reagents, some of which are in short supply, and (ii) expertise and manpower to execute, and is thus not always feasible in a busy hospital setting. Skin tests are positive in between 0.8% and 4% and of patients. Of patients with a negative skin test given an oral challenge, only 0.8% to 1.5% of patients experience reactions, typically cutaneous rather than anaphylactic. A recent study challenged 328 low risk penicillin allergic outpatients with a single dose of oral amoxicillin, without prior skin testing. There were only 5 (1.5%) cutaneous reactions, with no episodes of anaphylaxis. There have been no studies assessing direct oral challenge of hospital inpatients, but successful approaches utilising skin testing to determine allergy status in hospital inpatients. Based on this data and the low rate of 'true' allergy in the form of immediate hypersensitivity amongst reportedly penicillin allergic patients, we feel that it should be feasible to administer an oral challenge to carefully selected low risk hospital inpatients. The ASCIA guidelines suggest that in cases where the clinical history does not suggest an IgE mediated allergy, skin testing is not required, and a direct oral challenge may be given. This will enable a more proactive, real time stewardship intervention than skin testing, which is often delayed to the outpatient setting.

No related papers found yet.