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Moreno-Nuñez L, Rosado-Ingelmo A, González-Moreno A, Martín-Segarra O, Hervás-Gómez R, Sanz-Márquez S, Pérez-Fernández E, Losa-García JE, Tejedor-Alonso MA. Integration of beta-lactam allergy evaluation in a Spanish antibiotic stewardship programme. Clin Exp Allergy 2023; 53:1314-1317. [PMID: 37669809 DOI: 10.1111/cea.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Leonor Moreno-Nuñez
- Infectious Disease Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ana Rosado-Ingelmo
- Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Oriol Martín-Segarra
- Infectious Disease Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Rafael Hervás-Gómez
- Infectious Disease Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Sira Sanz-Márquez
- Pharmacy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Powell N, Upton M, Kent B, Tonkin-Crine S, Sandoe J. Is penicillin allergy de-labelling about to find its place in UK antimicrobial stewardship strategy? Clin Med (Lond) 2023; 23:76-77. [PMID: 36650063 PMCID: PMC11046535 DOI: 10.7861/clinmed.2022-0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hirai S, Yamamoto-Hanada K, Kabashima S, Fukuie T, Shoji K, Ozawa K, Sago H, Ohya Y. [ANTIMICROBIAL ALLERGY ASSESSMENT DURING PREGNANCY FOR APPROPRIATE ANTIMICROBIAL USE AT DELIVERY]. Arerugi 2023; 72:1223-1229. [PMID: 38092398 DOI: 10.15036/arerugi.72.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Avoidance of suspect drugs based solely on a history of drug allergy is detrimental to disease outcomes. Many antimicrobial allergy labels are not usually true allergy. Some studies have demonstrated that antimicrobial allergy assessments can be safely performed on pregnant women. The purpose of this study was to examine the usefulness of antibiotic allergy assessment during pregnancy in Japan. METHODS We reviewed pregnant women who reported antimicrobial allergies and were referred to the allergy center. Allergists conducted an interview and skin test and selected antibiotics that could be used at delivery. RESULTS Twenty-four pregnant women were referred to as having antimicrobial allergies. Most of the suspected antimicrobials were cephalosporin (13 cases, 52%) and penicillin (9 cases, 36%). Five women were ruled out only by our interviews. Of the remaining 20 cases, 10 were immediate type, 6 were non-immediate type, and 4 were unknown. All 21 pregnant women who needed antimicrobials were able to use the first-line drugs (β-lactam antimicrobials) at the time of delivery. No surgical site infections or allergic reactions were observed. CONCLUSION Pregnant women with antimicrobial allergy labels could be evaluated by antimicrobial allergy assessment during pregnancy, and first-line antimicrobials were safely and properly used at delivery.
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Affiliation(s)
- Seiko Hirai
- Allergy Center, National Center for Child Health and Development
| | | | | | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development
| | - Katsusuke Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development
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Savic L, Ardern-Jones M, Avery A, Cook T, Denman S, Farooque S, Garcez T, Gold R, Jay N, Krishna MT, Leech S, McKibben S, Nasser S, Premchand N, Sandoe J, Sneddon J, Warner A. BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. Clin Exp Allergy 2022; 52:1135-1141. [PMID: 36128691 DOI: 10.1111/cea.14217] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 01/26/2023]
Abstract
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de-labelling service for their patients. It is intended to supplement the BSACI 2015 guideline "Management of allergy to penicillin and other beta-lactams" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta-lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy.
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Affiliation(s)
- Louise Savic
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael Ardern-Jones
- Faculty of Medicine, University of Southampton, Southamptom, UK.,Department of Dermatology, University Hospitals Southampton NHS Foundation Trust, Southamptom, UK
| | - Anthony Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Cook
- Department of Anaesthesia and Intensive Care, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah Denman
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sophie Farooque
- Department of Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - Tomaz Garcez
- Dept of Immunology, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Nicola Jay
- Department of Paediatric Allergy, Sheffield Childrens NHS Foundation Trust, Sheffield, UK
| | - Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sue Leech
- Department of Paedaitric Allergy, Kings College Hospital NHS Foundation Trust, London, UK
| | - Shauna McKibben
- Department of Asthma and Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nikhil Premchand
- Department of Clinical Infection, Northumbria Healthcare NHS Foundation Trust, Newcastle, UK
| | - Jonathan Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jacqueline Sneddon
- British Society for Antimicrobial Chemotherapy, Birmingham, UK.,Health Improvement Scotland, Glasgow, UK
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Madrigal‐Burgaleta R, Vazquez‐Revuelta P, Marti‐Garrido J, Lleonart‐Bellfill R, Ali FR, Alvarez‐Cuesta E. Medical algorithm: Diagnosis and treatment of hypersensitivity reactions to cancer chemotherapy. Allergy 2021; 76:2636-2640. [PMID: 33683735 DOI: 10.1111/all.14810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Ricardo Madrigal‐Burgaleta
- Allergy & Severe Asthma Service St Bartholomew’s HospitalBarts Health NHS Trust London UK
- Drug Desensitisation Centre Catalan Institute of Oncology Barcelona Spain
| | - Paula Vazquez‐Revuelta
- Drug Desensitisation Centre Catalan Institute of Oncology Barcelona Spain
- Allergy Service Internal Medicine Department Bellvitge University Hospital Barcelona Spain
| | - Jaume Marti‐Garrido
- Drug Desensitisation Centre Catalan Institute of Oncology Barcelona Spain
- Allergy Service Internal Medicine Department Bellvitge University Hospital Barcelona Spain
| | - Ramon Lleonart‐Bellfill
- Drug Desensitisation Centre Catalan Institute of Oncology Barcelona Spain
- Allergy Service Internal Medicine Department Bellvitge University Hospital Barcelona Spain
| | - Fawzia Runa Ali
- Allergy & Severe Asthma Service St Bartholomew’s HospitalBarts Health NHS Trust London UK
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Savic L, Gurr L, Kaura V, Toolan J, Sandoe JAT, Hopkins PM, Savic S. Penicillin allergy de-labelling ahead of elective surgery: feasibility and barriers. Br J Anaesth 2018; 123:e110-e116. [PMID: 30915983 DOI: 10.1016/j.bja.2018.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Around 10-15% of the in-patient population carry unsubstantiated 'penicillin allergy' labels, the majority incorrect when tested. These labels are associated with harm from use of broad-spectrum non-penicillin antibiotics. Current testing guidelines incorporate both skin and challenge tests; this is prohibitively expensive and time-consuming to deliver on a large scale. We aimed to establish the feasibility of a rapid access de-labelling pathway for surgical patients, using direct oral challenge. METHODS 'Penicillin allergic' patients, recruited from a surgical pre-assessment clinic, were risk-stratified using a screening questionnaire. Patients at low risk of true, immunoglobulin E (IgE)-mediated allergy were offered direct oral challenge using incremental amoxicillin to a total dose of 500 mg. A 3-day course was completed at home. De-labelled patients were followed up to determine antibiotic use in surgery, and attitudes towards de-labelling were explored. RESULTS Of 219 patients screened, 74 were eligible for inclusion and offered testing. We subsequently tested 56 patients; 55 were de-labelled. None had a serious reaction to the supervised challenge, or thereafter. On follow-up, 17 of 19 patients received appropriate antimicrobial prophylaxis during surgery. Only three of 33 de-labelled patients would have been happy for the label to be removed without prior specialist testing. CONCLUSION Rapid access de-labelling, using direct oral challenge in appropriately risk-stratified patients, can be incorporated into the existing surgical care pathway. This provides immediate and potential long-term benefit for patients. Interest in testing is high among patients, and clinicians appear to follow clinic recommendations. Patients are unlikely to accept removal of their allergy label on the basis of history alone. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: AN17/92982.
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Affiliation(s)
- L Savic
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - L Gurr
- University of Leeds School of Medicine, Leeds, UK
| | - V Kaura
- Leeds Institute of Biomedical and Clinical Sciences, Leeds, UK
| | - J Toolan
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A T Sandoe
- University of Leeds School of Medicine, Leeds, UK; Microbiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P M Hopkins
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, Leeds, UK
| | - S Savic
- University of Leeds School of Medicine, Leeds, UK; Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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