APAAACI clinical pathway on direct provocation testing for penicillin allergy delabeling.

Allergy delabeling penicillin stewardship

Journal

Asia Pacific allergy
ISSN: 2233-8276
Titre abrégé: Asia Pac Allergy
Pays: Netherlands
ID NLM: 101561954

Informations de publication

Date de publication:
Dec 2023
Historique:
received: 13 07 2023
accepted: 27 09 2023
medline: 14 12 2023
pubmed: 14 12 2023
entrez: 14 12 2023
Statut: ppublish

Résumé

Allergy to penicillin is commonly reported in many countries and is an overwhelming global public health concern. Penicillin allergy labels can lead to the use of less effective antibiotics and can be associated with antimicrobial resistance. Appropriate assessment of suspected penicillin allergy (often including skin testing, followed by drug provocation testing [DPT] performed by allergists) can prevent the unnecessary restriction of penicillin or delabelling. Many countries in the Asia Pacific (AP) have very limited access to allergy services, and there are significant disparities in the methods of evaluating penicillin allergy. Therefore, a clinical pathway for the management of penicillin allergy is essential. To develop a risk-stratified clinical pathway for delabeling penicillin allergy, taking into account the distinct epidemiology, patient/sensitization profiles, and disparities of allergy services or facilities within the AP. A risk-stratified penicillin allergy delabeling clinical pathway was formulated by the Drug Allergy Committee of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. and members of the Penicillin Allergy Disparities survey in AP each representing one country/region of the AP. The clinical pathway was tested based on a database of anonymized patients who were sequentially referred for and completed penicillin allergy evaluation in Hong Kong. The clinical pathway was piloted employing a "hub-and-spoke" approach to foster multidisciplinary collaboration between allergists and nonallergists. A simulation run of the algorithm on a retrospective Hong Kong cohort of 439 patients was performed. Overall, 367 (84%) of patients were suitable for direct DPT and reduced the need for skin testing or specialist's care for 357 (97%) skin test-negative individuals. Out of the skin test-negative patients, 345 (94%) patients had a negative DPT. This risk-stratification strategy for direct oral DPT can reduce the need for unnecessary skin testing in patients with low-risk penicillin allergy histories. The hub and spoke model of care may be considered for further piloting and validation in other AP populations that lack adequately trained allergists.

Sections du résumé

Background UNASSIGNED
Allergy to penicillin is commonly reported in many countries and is an overwhelming global public health concern. Penicillin allergy labels can lead to the use of less effective antibiotics and can be associated with antimicrobial resistance. Appropriate assessment of suspected penicillin allergy (often including skin testing, followed by drug provocation testing [DPT] performed by allergists) can prevent the unnecessary restriction of penicillin or delabelling. Many countries in the Asia Pacific (AP) have very limited access to allergy services, and there are significant disparities in the methods of evaluating penicillin allergy. Therefore, a clinical pathway for the management of penicillin allergy is essential.
Objectives UNASSIGNED
To develop a risk-stratified clinical pathway for delabeling penicillin allergy, taking into account the distinct epidemiology, patient/sensitization profiles, and disparities of allergy services or facilities within the AP.
Methods UNASSIGNED
A risk-stratified penicillin allergy delabeling clinical pathway was formulated by the Drug Allergy Committee of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. and members of the Penicillin Allergy Disparities survey in AP each representing one country/region of the AP. The clinical pathway was tested based on a database of anonymized patients who were sequentially referred for and completed penicillin allergy evaluation in Hong Kong.
Results UNASSIGNED
The clinical pathway was piloted employing a "hub-and-spoke" approach to foster multidisciplinary collaboration between allergists and nonallergists. A simulation run of the algorithm on a retrospective Hong Kong cohort of 439 patients was performed. Overall, 367 (84%) of patients were suitable for direct DPT and reduced the need for skin testing or specialist's care for 357 (97%) skin test-negative individuals. Out of the skin test-negative patients, 345 (94%) patients had a negative DPT.
Conclusions UNASSIGNED
This risk-stratification strategy for direct oral DPT can reduce the need for unnecessary skin testing in patients with low-risk penicillin allergy histories. The hub and spoke model of care may be considered for further piloting and validation in other AP populations that lack adequately trained allergists.

Identifiants

DOI: 10.5415/apallergy.0000000000000122 PMID: 38094092 PMC: PMC10715740
pubmed: 38094092
doi: 10.5415/apallergy.0000000000000122
pmc: PMC10715740
doi:

Types de publication

Journal Article

Langues

eng

Pagination

142-147

Informations de copyright

Copyright © 2023. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.

Déclaration de conflit d'intérêts

The authors have no financial conflict of interest.

Auteurs

Philip Hei Li (PH)

Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.

Bernard Yu-Hor Thong (BY)

Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.

Ruby Pawankar (R)

Department of Pediatrics, Nippon Medical School, Tokyo, Japan.

Chandima Jeewandara (C)

Allergy Immunology and Cell Biology Unit, University of Sri Jayewardenepura, Sri Lanka.

Rommel Crisenio M Lobo (RCM)

Fe del Mundo Medical Center, Quezon City, Philippines.

Hye-Ryun Kang (HR)

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine/Seoul National University Hospital, South Korea.

Padukudru Anand Mahesh (PA)

Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, Karnataka, India.

Juan Meng (J)

Allergy Center, West China Hospital, Sichuan University, China.

Sonomjamts Munkhbayarlakh (S)

Department of Pulmonology & Allergology, School of Medicine, Mongolian National University of Medical Sciences, Mongolia.

Duy Le Pham (DL)

Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

Ticha Rerkpattanapipat (T)

Allergy Immunology and Rheumatology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.

Min-Moon Tang (MM)

Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Masao Yamaguchi (M)

Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Ichihara-shi, Chiba, Japan.

Amir Hamzah Abdul Latiff (AH)

Allergy & Immunology Centre Pantai Hospital Kuala Lumpur, Malaysia.

Iris Rengganis (I)

Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

Jiu-Yao Wang (JY)

Allergy, Immunology, and Microbiome (A.I.M.) Research Centre, China Medical University Children's Hospital, Taichung, Taiwan.

Luo Zhang (L)

Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

Michaela Lucas (M)

Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth Children's Hospital, Perth, Western Australia, Australia.
Medical School, University of Western Australia, Nedlands, Western Australia, Australia.

Classifications MeSH