Direct oral amoxicillin challenge without antecedent penicillin skin testing in low-risk patients

2018 ◽  
Vol 121 (5) ◽  
pp. 627-628 ◽  
Author(s):  
Merin Kuruvilla ◽  
Jamie Thomas
Keyword(s):  
Skin Testing ◽  
Low Risk ◽  
Oral Amoxicillin ◽  
Risk Patients

scholarly journals First pediatric electronic algorithm to stratify risk of penicillin allergy

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Hannah Roberts ◽  
Lianne Soller ◽  
Karen Ng ◽  
Edmond S. Chan ◽  
Ashley Roberts ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Pediatric Population ◽  
Skin Testing ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Oral Drug ◽  
Beta Lactam ◽  
Paper Version ◽  
Pediatric Study ◽  
Risk Patients

AbstractBeta-lactam allergy is reported in 5–10% of children in North America, but up to 94–97% of patients are deemed not allergic after allergist assessment. The utility of standardized skin testing for penicillin allergy in the pediatric population has been recently questioned. Oral drug challenges when appropriate, are preferred over skin testing, and can definitively rule out immediate, IgE-mediated drug allergy. To our knowledge, this is the only pediatric study to assess the reliability of a penicillin allergy stratification tool using a paper and electronic clinical algorithm. By using an electronic algorithm, we identified 61 patients (of 95 deemed not allergic by gold standard allergist decision) as low risk for penicillin allergy, with no false negatives and without the need for allergist assessment or skin testing. In this study, we demonstrate that an electronic algorithm can be used by various pediatric clinicians when evaluating possible penicillin allergy to reliably identify low risk patients. We identified the electronic algorithm was superior to the paper version, capturing an even higher percentage of low risk patients than the paper version. By developing an electronic algorithm to accurately assess penicillin allergy risk based on appropriate history, without the need for diagnostic testing or allergist assessment, we can empower non-allergist health care professionals to safely de-label low risk pediatric patients and assist in alleviating subspecialty wait times for penicillin allergy assessment.

scholarly journals 1332. Single Dose Oral Amoxicillin Challenge is a Safe and Effective Strategy to Delabel Penicillin Allergies among Low Risk Hospitalized Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S677-S678
Author(s):  
Justin B Searns ◽  
Amy Stein ◽  
Christine MacBrayne ◽  
Tara Sarin ◽  
Taylor Lin ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Risk Assessment Tool ◽  
Effective Strategy ◽  
Oral Amoxicillin ◽  
Treatment Dose ◽  
Risk Patients ◽  
Drug Challenge

Abstract Background Over 90% of children with reported penicillin allergy can tolerate penicillin without incident. Developing effective and safe strategies to remove inappropriate penicillin allergies has the potential to improve care; however, guidance on how to identify, test, and delabel patients is limited. Methods In April 2019, Children’s Hospital Colorado (CHCO) implemented a penicillin allergy clinical pathway (CP) alongside a risk assessment tool to stratify patients based on allergic history (Figure 1). Patients at “no increased risk” were educated and delabeled without testing. Low risk patients were offered an oral amoxicillin drug challenge with close observation. A single, non-graded, treatment dose of amoxicillin (45 mg/kg, max dose 1000mg) was used for low risk patients, and no preceding allergic skin testing was performed. Patients with no signs or symptoms of allergic response 60 minutes after amoxicillin administration were delabeled. Children delabeled of penicillin allergies on the CHCO hospital medicine service were compared between the pre-CP (1/1/17-3/31/19) and post-CP (4/1/19-3/31/20) cohorts. Figure 1. Penicillin Allergy Risk Assessment Results Pre-CP, 683/10624 (6.4%) patients reported a penicillin allergy and 18/683 (2.6%) were delabeled by discharge. Post-CP, 345/6559 (5.3%) patients reported a penicillin allergy and 47/345 (13.6%) were delabeled by discharge (P-value < 0.0001, Figure 2). Among the 47 post-CP patients, 11 were delabeled by history alone, 19 underwent oral amoxicillin drug challenge per CP, and 17 received a different treatment dose penicillin per treatment team. Only one penicillin-exposed patients had a reaction. This patient developed a delayed, non-progressive rash and had penicillin allergy restored to their chart. No patient required emergency medical intervention, and none were “relabeled” penicillin allergic in the 6 months following discharge. Figure 2. Monthly Rate of Penicillin Allergic Patients Delabeled by Discharge Conclusion A drug challenge using a single non-graded dose of oral amoxicillin is a safe and effective strategy to delabel low risk children of inappropriate penicillin allergies when implemented alongside a risk assessment tool. Further studies are needed to evaluate the long-term benefits of delabeling inappropriate penicillin allergies and to continue monitoring for adverse events. Disclosures All Authors: No reported disclosures

Risk Stratification as a Predictive Factor for Cephalosporin Allergy: A Case-Controlled Study

2021 ◽  
pp. 1-8
Author(s):  
Ayse Suleyman ◽  
Sadık Toprak ◽  
Nermin Guler
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Skin Testing ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Low Risk ◽  
Skin Tests ◽  
Controlled Study ◽  
Risk Patients ◽  
Immediate Reactions

<b><i>Background:</i></b> Compared to penicillin, cephalosporin allergies are less common in children, and their diagnostic approach is less standardized. A recent European Academy of Allergy and Clinical Immunology position paper provided a risk stratification system for patients with suspected β-lactam hypersensitivity reactions. <b><i>Objective:</i></b> This study aimed to evaluate risk stratification and predicting factors for confirmed cephalosporin hypersensitivity. <b><i>Methods:</i></b> The case-controlled study included patients with confirmed cephalosporin hypersensitivity (skin tests, <i>n</i> = 53; drug provocation, <i>n</i> = 19). For each patient, 2 age- and gender-matched control subjects were included in the study. Data were retrieved from patients’ records and analyzed retrospectively. Risk stratification was performed according to the severity of index reactions, which was initially divided as high and low risk and then further divided as immediate and nonimmediate. <b><i>Results:</i></b> According to risk stratification, the patient and control groups were divided as follows: high-risk immediate (66.7% vs. 13%, respectively), high-risk delayed (1.4% vs. 8.3%, respectively), low-risk immediate (16.7% vs. 16%, respectively), and low-risk delayed (15.3% vs. 62.9%, respectively). Immediate reactions (odds ratio [OR]: 12.1, 95% confidence interval [CI]: 9–24.8, <i>p</i> &#x3c; 0.001) and high-risk reactions (OR: 7.8, 95% CI: 4.1–14.6, <i>p</i> &#x3c; 0.001) were associated with confirmed cephalosporin hypersensitivity in univariate analysis. Multivariate regression analysis indicated that immediate reactions (OR: 7.5, 95% CI: 3.3–16.8, <i>p</i> &#x3c; 0.001) and high-risk reactions (OR: 5.2, 95% CI: 2.1–12.9, <i>p</i> &#x3c; 0.001) were significant risk factors for the prediction of cephalosporin hypersensitivity. <b><i>Conclusion:</i></b> This model can be applied in children with suspected cephalosporin allergy. Skin testing provides diagnostic information in high-risk patients with immediate reactions and reduces the need for drug provocation testing in these patients. It is highly likely to confirm the diagnosis of low-risk patients directly with provocation tests without skin tests. High-risk and immediate reactions were found to be predictive factors for confirmed cephalosporin allergy.

scholarly journals Is direct oral amoxicillin challenge a viable approach for ‘low-risk’ patients labelled with penicillin allergy?

2019 ◽  
Vol 74 (9) ◽  
pp. 2475-2479 ◽  
Author(s):  
Mamidipudi T Krishna ◽  
Siraj A Misbah
Keyword(s):  
Public Health Problem ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Major Public Health Problem ◽  
Healthcare Settings ◽  
Oral Amoxicillin ◽  
Risk Patients ◽  
Barriers To Implementation ◽  
Facilitators And Barriers ◽  
Viable Approach

Abstract Spurious penicillin allergy (PenA) is a major public health problem. Up to 10% of the population and 20% of inpatients are labelled with PenA, but only <5%–10% have a proven allergy following comprehensive investigations. PenA tests are labour intensive and require specialist input, which may not be readily available due to limited allergy services. Therefore, patients with PenA receive alternative antibiotics that are associated with higher rates of iatrogenic infections, antimicrobial resistance and a longer hospital stay with consequent increased costs. Recent evidence suggests that a supervised ‘direct’ oral amoxicillin challenge (without performing allergy tests) is a safe option in low-risk patients (those least likely to be allergic based on history). Patient selection for this procedure is based on a careful guideline-based risk stratification process. Further research is needed to validate this intervention in routine clinical practice and explore potential facilitators and barriers to implementation in different healthcare settings.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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