TY - JOUR
T1 - Penicillin allergy de-labelling by non-Allergists
T2 - A comparison of testing protocols
AU - Powell, Neil
AU - Elkhalifa, Shuayb
AU - Sandoe, Jonathan
N1 - Publisher Copyright:
© 2023 The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Optimizing penicillin allergy de-labelling (PADL) to ensure patients with an incorrect penicillin allergy record are de-labelled with minimal patient harm is important for antibiotic stewardship. The heterogeneity of inclusion and exclusion criteria in the published penicillin allergy testing protocols risks suboptimal delivery of PADL. We compared the similarities and the differences between non-Allergist-delivered PADL testing protocols and make suggestions for harmonization. The observed variation in testing practice has two broad elements: (i) definitions and terminology; and (ii) differences in the acceptability of perceived risk. All direct drug provocation testing (DDPT) protocols included patients with benign delayed rash as eligible for testing, although the remoteness of the rash, and the terminology used to describe the rash, differed. Patients with features of potential IgE reactions were excluded from most DDPT protocols, but not all of them. There was differing advice on how to manage patients who had subsequently tolerated penicillin since the index reaction and differences in which patients were considered ineligible for DDPT due to acuity of illness, comorbidities and concomitant medications. Standardization of the terminology used in penicillin allergy testing protocols and consensus on inclusion and exclusion criteria are required for safe and efficient PADL delivery at scale by non-Allergists.
AB - Optimizing penicillin allergy de-labelling (PADL) to ensure patients with an incorrect penicillin allergy record are de-labelled with minimal patient harm is important for antibiotic stewardship. The heterogeneity of inclusion and exclusion criteria in the published penicillin allergy testing protocols risks suboptimal delivery of PADL. We compared the similarities and the differences between non-Allergist-delivered PADL testing protocols and make suggestions for harmonization. The observed variation in testing practice has two broad elements: (i) definitions and terminology; and (ii) differences in the acceptability of perceived risk. All direct drug provocation testing (DDPT) protocols included patients with benign delayed rash as eligible for testing, although the remoteness of the rash, and the terminology used to describe the rash, differed. Patients with features of potential IgE reactions were excluded from most DDPT protocols, but not all of them. There was differing advice on how to manage patients who had subsequently tolerated penicillin since the index reaction and differences in which patients were considered ineligible for DDPT due to acuity of illness, comorbidities and concomitant medications. Standardization of the terminology used in penicillin allergy testing protocols and consensus on inclusion and exclusion criteria are required for safe and efficient PADL delivery at scale by non-Allergists.
UR - http://www.scopus.com/inward/record.url?scp=85180570148&partnerID=8YFLogxK
UR - https://pearl.plymouth.ac.uk/context/nm-research/article/1579/viewcontent/dlad134.pdf
U2 - 10.1093/jacamr/dlad134
DO - 10.1093/jacamr/dlad134
M3 - Article
AN - SCOPUS:85180570148
SN - 2632-1823
VL - 5
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 6
M1 - dlad134
ER -