Savic, L, Gurr, L, Kaura, V orcid.org/0000-0002-8984-9662 et al. (4 more authors) (2019) Penicillin allergy de-labelling ahead of elective surgery: feasibility and barriers. British Journal of Anaesthesia, 123 (1). e110-e116. ISSN 0007-0912
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. This is an author produced version of a paper published in British Journal of Anaesthesia. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | allergy; anaphylaxis; antibiotics; de-labelling; perioperative; preoperative assessment |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Molecular Gastroenterology (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Inst of Biomed & Clin Sciences (LIBACS) (Leeds) > Trans Anaesthetics & Surgical Sciences (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 17 Aug 2018 11:35 |
Last Modified: | 19 Oct 2019 00:39 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.bja.2018.09.009 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:134590 |