scholarly journals P003 DIAGNOSTIC UTILITY OF PEG/POLYSORBATE 80 SKIN TESTING AND ORAL CHALLENGE FOR COVID-19 MRNA VACCINE ALLERGY

2021 ◽  
Vol 127 (5) ◽  
pp. S19-S20
Author(s):  
J. Ohtola ◽  
D. Lang ◽  
L. Pien
Keyword(s):  
Skin Testing ◽  
Oral Challenge ◽  
Diagnostic Utility ◽  
Polysorbate 80

scholarly journals The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings in Immunocompromised Cancer Patients

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Farnaz Foolad ◽  
Sheila Berlin ◽  
Candice White ◽  
Emma Dishner ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Cost Savings ◽  
Hematologic Malignancies ◽  
Oral Challenge ◽  
Beta Lactam ◽  
History Of ◽  
Antibiotic Cost ◽  
The Impact

Abstract Objective Reported penicillin allergies result in alternative antimicrobial use and are associated with worse outcomes and increased costs. Penicillin skin testing (PST) has recently been shown to be safe and effective in immunocompromised cancer patients, yet its impact on antimicrobial costs and aztreonam utilization has not been evaluated in this population. Method From September 2017 to January 2018, we screened all admitted patients receiving aztreonam. Those with a self-reported history of possible immunoglobulin E (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge. Results A total of 129 patients were screened, and 49 patients were included and underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) tested negative, 1 patient tested positive on oral challenge, and 2 patients had indeterminate results. The median time from admission to testing was 2 days (interquartile range, 1–4). After testing negative, 33 patients (72%) were switched to beta-lactam therapy, which resulted in a total of 390 days of beta-lactam therapy. For identical therapy durations, the direct total antibiotic cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting in $63 192.61 in projected savings. A significant reduction in median days of aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during the intervention period. Conclusions Use of PST in immunocompromised cancer patients receiving aztreonam resulted in improved aztreonam stewardship and significant cost savings. Our study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies.

scholarly journals Biphasic anaphylaxis after first dose of mRNA COVID-19 vaccine with positive polysorbate 80 skin testing

2021 ◽  
Author(s):  
Mitchell M Pitlick ◽  
Miguel A Park ◽  
Alexei Gonzalez-Estrada ◽  
Sergio E Chiarella
Keyword(s):  
Skin Testing ◽  
Polysorbate 80

scholarly journals Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review

2019 ◽  
Vol 39 (6) ◽  
pp. e1-e9
Author(s):  
Homood A. Alharbi
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Skin Test ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Oral Challenge ◽  
Acute Tolerance ◽  
Care Providers

Background Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E–mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. Objective To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. Methods This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. Results Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. Conclusions Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.

Oral challenge without skin testing in children with suspected non‐severe betalactam hypersensitivity

2019 ◽  
Vol 30 (4) ◽  
pp. 488-490 ◽  
Author(s):  
Guillaume Pouessel ◽  
Nicolas Winter ◽  
Stéphanie Lejeune ◽  
Caroline Thumerelle ◽  
Antoine Deschildre
Keyword(s):  
Skin Testing ◽  
Oral Challenge

scholarly journals Intradermal Skin Testing and Oral Challenge for Patients Labeled as Fluoroquinolone Allergic

2020 ◽  
Vol 145 (2) ◽  
pp. AB337
Author(s):  
Matthew Krantz ◽  
Cosby Stone ◽  
Roger Yu ◽  
Sarah Adams ◽  
Elizabeth Phillips
Keyword(s):  
Skin Testing ◽  
Oral Challenge

scholarly journals 998. Challenging Penicillin Allergies: Pharmacist led program in a community hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S351-S351
Author(s):  
Radha Patel ◽  
Nicole Saccone ◽  
Kent Stock ◽  
Sara Utley ◽  
Dawn Bouknight
Keyword(s):  
Removal Rate ◽  
Skin Testing ◽  
The United States ◽  
Electronic Medical Record System ◽  
Primary Objective ◽  
Oral Challenge ◽  
Negative Consequences ◽  
Infectious Disease Physician ◽  
Record System ◽  
The Impact

Abstract Background Penicillin (PCN) allergy has been approximated to be reported in 10% of the United States population. Studies utilizing PCN skin testing have demonstrated that less than 1% of the population have a true PCN allergy. With increasing data on the negative consequences associated with a PCN allergy diagnosis, correctly identifying these patients is imperative. PCN skin testing has resulted in high rates of penicillin de-labeling; however, there are limited data evaluating the impact of a pharmacist-led PCN allergy evaluation with removal through utilization of oral challenges. The aim of this study was to utilize pharmacists to correctly identify those who are not penicillin-allergic to help decrease unnecessary use of broad-spectrum antibiotics and to optimize therapy. Methods This is a single-center, prospective review looking at a 10-month period of a pharmacist-led de-labeling project of patients with a PCN allergy. The electronic medical record system and decision support software were used to identify eligible patients. Adults ≥18 years of age with a PCN allergy were included. During the evaluation, pharmacists utilized a series of standardized questions which was reviewed with the infectious disease physician to classify the patient’s allergy. Based on classification a protocol was followed that either led to the patient retaining their allergy, or removal. The primary objective is to evaluate the rate of removal of penicillin allergies. Secondary objectives reviewed removal rate of patients on active antibiotics, and evaluate how many were switched to β-lactam. Results A total of 492 patients with PCN allergies were interviewed by a pharmacist. Pharmacist de-labeled 99/492 (20%) PCN allergies. Of those patients, 23% were removed through oral challenge and 76% through patient history. There were 175 patients on active antibiotics and 52/175 (30%) had their allergies removed. Finally, 36/52 (69%) were switched to a β-lactam. Conclusion A pharmacist-led penicillin allergy de-labeling project is beneficial in reducing PCN allergies when skin testing is unavailable in community hospitals. As seen about 1 in 5 patients were able to remove their allergy through allergy evaluation or oral challenge. Furthermore, pharmacist evaluation of the allergy not only helped remove the allergy but also resulted in the most appropriate antibiotic. Disclosures All authors: No reported disclosures.

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