PMID- 30915983
OWN - NLM
STAT- MEDLINE
DCOM- 20190624
LR  - 20190624
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 123
IP  - 1
DP  - 2019 Jul
TI  - Penicillin allergy de-labelling ahead of elective surgery: feasibility and 
      barriers.
PG  - e110-e116
LID - S0007-0912(18)30752-9 [pii]
LID - 10.1016/j.bja.2018.09.009 [doi]
AB  - 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.
CI  - Copyright (c) 2018 British Journal of Anaesthesia. All rights reserved.
FAU - Savic, L
AU  - Savic L
AD  - Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic 
      address: louise.savic@nhs.net.
FAU - Gurr, L
AU  - Gurr L
AD  - University of Leeds School of Medicine, Leeds, UK.
FAU - Kaura, V
AU  - Kaura V
AD  - Leeds Institute of Biomedical and Clinical Sciences, Leeds, UK.
FAU - Toolan, J
AU  - Toolan J
AD  - Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS 
      Trust, Leeds, UK.
FAU - Sandoe, J A T
AU  - Sandoe JAT
AD  - University of Leeds School of Medicine, Leeds, UK; Microbiology Department, Leeds 
      Teaching Hospitals NHS Trust, Leeds, UK.
FAU - Hopkins, P M
AU  - Hopkins PM
AD  - Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds 
      Institute of Biomedical and Clinical Sciences, Leeds, UK.
FAU - Savic, S
AU  - Savic S
AD  - University of Leeds School of Medicine, Leeds, UK; Department of Clinical 
      Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
LA  - eng
PT  - Journal Article
DEP - 20181019
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Penicillins)
RN  - 804826J2HU (Amoxicillin)
SB  - IM
MH  - Amoxicillin/*administration & dosage
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - Drug Hypersensitivity/*diagnosis
MH  - *Elective Surgical Procedures
MH  - Feasibility Studies
MH  - Humans
MH  - Penicillins/*administration & dosage
MH  - Preoperative Care/*methods
MH  - United Kingdom
OTO - NOTNLM
OT  - allergy
OT  - anaphylaxis
OT  - antibiotics
OT  - de-labelling
OT  - perioperative
OT  - preoperative assessment
EDAT- 2019/03/28 06:00
MHDA- 2019/06/25 06:00
CRDT- 2019/03/28 06:00
PHST- 2018/07/02 00:00 [received]
PHST- 2018/09/02 00:00 [revised]
PHST- 2018/09/03 00:00 [accepted]
PHST- 2019/03/28 06:00 [pubmed]
PHST- 2019/06/25 06:00 [medline]
PHST- 2019/03/28 06:00 [entrez]
AID - S0007-0912(18)30752-9 [pii]
AID - 10.1016/j.bja.2018.09.009 [doi]
PST - ppublish
SO  - Br J Anaesth. 2019 Jul;123(1):e110-e116. doi: 10.1016/j.bja.2018.09.009. Epub 
      2018 Oct 19.