Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing.
Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing.
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DOI：
10.1186/s13223-022-00659-1
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发表时间：
2022-03-22
期刊：
影响因子：
--
通讯作者：
Trautmann A
中科院分区：
文献类型：
--
作者：
Schrüfer P;Stoevesandt J;Trautmann A
青霉素过敏标签经常阻碍青霉素或其他β-内酰胺类抗生素的指南指导治疗。尽管假定过敏，但有针对性的询问可能表明致敏的可能性较低，并允许合理安全地使用所讨论的抗生素。在这项研究中，我们评估了一种标准化算法，旨在区分非过敏性患者与真正过敏性β-内酰胺超敏反应患者。我们在800例疑似β-内酰胺类超敏反应的连续患者中回顾性应用了去标记算法。在2009年至2019年期间，所有患者均接受了完整的过敏检查，可以明确排除或诊断β-内酰胺过敏。在评价的800例病例中，595例（74.4%）通过阴性激发试验排除β-内酰胺过敏。IgE介导的过敏反应70例（8.7%），迟发型超敏反应135例（16.9%）。在62例（88.6%）速发过敏反应病例中，算法正确建议使用替代抗生素。与有轻度反应史的患者（73.1%）相比，中度至重度过敏反应患者（97.7%）的准确性更高。该算法正确识别了122例（90.4%）经证实的迟发型超敏反应患者。它允许在595例诊断排除青霉素超敏反应的患者中的330例（55.5%）中取消标签，但未能将其余265例（44.5%）确定为低风险病例。该算法检测到89.8%的青霉素（β-内酰胺）过敏病例，灵敏度对于中度至重度过敏反应最佳。研究数据证明，在密切监督下实施标准化的去标签算法是合理的，以允许指南指导的治疗，并减少广谱抗生素的使用，作为抗生素管理计划的一部分。在线版本包含补充材料，可通过10.1186/s13223-022-00659-1获得。
Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity. We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019. In 595 (74.4%) out of 800 cases evaluated, β-lactam allergy could be excluded by negative challenge testing. IgE-mediated anaphylaxis was diagnosed in 70 (8.7%) patients, delayed-type hypersensitivity in 135 (16.9%). In 62 (88.6%) anaphylaxis cases, the algorithm correctly advised to use an alternative antibiotic. Accuracy was higher in patients with moderate to severe anaphylaxis (97.7%) compared to those with a history of mild reactions (73.1%). The algorithm correctly identified 122 (90.4%) patients with proven delayed-type hypersensitivity. It permitted de-labelling in 330 (55.5%) out of 595 patients with diagnostic exclusion of penicillin hypersensitivity, but failed to identify the remaining 265 (44.5%) as low-risk cases. The algorithm detected 89.8% of cases with penicillin (β-lactam) allergy, sensitivity was optimal for moderate to severe anaphylaxis. Study data justify the implementation of a standardized de-labelling algorithm under close supervision in order to permit guideline-directed treatment and reduce the use of broad-spectrum antibiotics as part of an antibiotic stewardship program. The online version contains supplementary material available at 10.1186/s13223-022-00659-1.
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影响因子：
5.9
作者：
King, Esther A.;Challa, Sridevi;Bielory, Leonard
通讯作者：
Bielory, Leonard
影响因子：
3.9
作者：
Trubiano J;Phillips E
通讯作者：
Phillips E
影响因子：
11.8
作者：
Blumenthal, Kimberly G.;Parker, Robert A.;Walensky, Rochelle P.
通讯作者：
Walensky, Rochelle P.
DOI：
10.1186/s13223-020-00488-0
发表时间：
2020-11-17
期刊：
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
影响因子：
--
作者：
Schrüfer P;Brockow K;Stoevesandt J;Trautmann A
通讯作者：
Trautmann A
影响因子：
3.4
作者：
Li, M.;Krishna, M. T.;Pillay, D.
通讯作者：
Pillay, D.