PMID- 32672891
OWN - NLM
STAT- MEDLINE
DCOM- 20220317
LR  - 20220317
IS  - 1445-5994 (Electronic)
IS  - 1444-0903 (Linking)
VI  - 52
IP  - 2
DP  - 2022 Feb
TI  - Oral amoxicillin challenge for low-risk penicillin allergic patients.
PG  - 295-300
LID - 10.1111/imj.14978 [doi]
AB  - BACKGROUND: Penicillin allergy is the most reported adverse drug reaction (ADR). 
      Being labelled with 'penicillin allergy' is associated with suboptimal antibiotic 
      therapy and poor patient outcomes. Most labelled with 'penicillin allergy' are at 
      low risk of harm from penicillins and guidelines recommend testing for accurate 
      diagnosis. Although skin testing is recommended to exclude immunoglobulin E 
      (IgE)-mediated reactions, there is limited access in most settings. AIMS: To 
      evaluate oral amoxicillin challenge without prior skin testing for patients 
      labelled with 'penicillin allergy' assessed as low risk during hospital 
      admission. METHODS: General Medical inpatients with a 'penicillin allergy' label 
      were assessed. For those who had tolerated a penicillin since the index event, 
      the ADR label was removed. Those assessed as 'low risk' were administered 250 mg 
      amoxicillin orally without prior skin testing. The durability of de-labelling was 
      subsequently assessed by review of clinical records. RESULTS: Of 224 patients 
      with a history of a penicillin ADR, 162 (72%) were low risk. A further 12 were 
      excluded and of the remaining 150, 56 (37%) had tolerated penicillins since their 
      index reaction and were de-labelled without challenge, 15 (10%) with a 
      non-allergic history were de-labelled. The remaining 79 were offered an oral 
      amoxicillin challenge; 38 declined and 41 tolerated amoxicillin. Overall, 112 of 
      the 224 (50%) patients had their ADR label removed. CONCLUSIONS: A careful ADR 
      history enables de-labelling of many patients. An oral amoxicillin challenge 
      without prior skin testing is safe and feasible for low-risk penicillin allergic 
      patients while in hospital.
CI  - (c) 2020 Royal Australasian College of Physicians.
FAU - Livirya, Silabhakta
AU  - Livirya S
AUID- ORCID: 0000-0002-2820-4721
AD  - General Medicine, Hawke's Bay Hospital, Hastings, New Zealand.
FAU - Pithie, Alan
AU  - Pithie A
AD  - Department of Infectious Diseases, General Medicine, Christchurch Hospital, 
      Christchurch, New Zealand.
FAU - Chua, Ignatius
AU  - Chua I
AD  - Department of Clinical Immunology, Christchurch Hospital, Christchurch, New 
      Zealand.
FAU - Hamilton, Niall
AU  - Hamilton N
AD  - Departments of Infectious Diseases, General Medicine, Auckland City Hospital, 
      Christchurch, New Zealand.
FAU - Doogue, Matthew
AU  - Doogue M
AD  - Department of Clinical Pharmacology, Infectious Diseases, Christchurch Hospital, 
      Christchurch, New Zealand.
AD  - Department of General Medicine, University of Otago, Christchurch, New Zealand.
FAU - Isenman, Heather
AU  - Isenman H
AD  - Department of Infectious Diseases, General Medicine, Christchurch Hospital, 
      Christchurch, New Zealand.
LA  - eng
GR  - Canterbury Medical Research Foundation/
PT  - Journal Article
DEP - 20220112
PL  - Australia
TA  - Intern Med J
JT  - Internal medicine journal
JID - 101092952
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Penicillins)
RN  - 804826J2HU (Amoxicillin)
SB  - IM
MH  - Amoxicillin/adverse effects
MH  - Anti-Bacterial Agents/adverse effects
MH  - *Drug Hypersensitivity/diagnosis/epidemiology
MH  - Humans
MH  - *Penicillins/adverse effects
MH  - Skin Tests
OTO - NOTNLM
OT  - adverse drug reaction
OT  - allergy
OT  - antibiotic
OT  - drug challenge
OT  - penicillin
EDAT- 2020/07/17 06:00
MHDA- 2022/03/18 06:00
CRDT- 2020/07/17 06:00
PHST- 2020/07/05 00:00 [revised]
PHST- 2020/02/17 00:00 [received]
PHST- 2020/07/05 00:00 [accepted]
PHST- 2020/07/17 06:00 [pubmed]
PHST- 2022/03/18 06:00 [medline]
PHST- 2020/07/17 06:00 [entrez]
AID - 10.1111/imj.14978 [doi]
PST - ppublish
SO  - Intern Med J. 2022 Feb;52(2):295-300. doi: 10.1111/imj.14978. Epub 2022 Jan 12.