Oral amoxicillin challenge for low-risk penicillin allergic patients
Silabhakta Livirya1, Alan Pithie2, Ignatius Chua3
1General Medicine, Hawke's Bay Hospital, Hastings, New Zealand.
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.
Insights
Many patients labeled with penicillin allergy can be safely de-labeled. An oral amoxicillin challenge without skin testing is a feasible approach for low-risk individuals during hospital stays, improving antibiotic therapy.
Area of Science:
- Clinical Medicine
- Pharmacology
- Infectious Diseases
Background:
- Penicillin allergy is the most frequently reported adverse drug reaction (ADR).
- Incorrect penicillin allergy labels lead to suboptimal antibiotic use and poorer patient outcomes.
- Guidelines recommend allergy testing to accurately diagnose penicillin hypersensitivity, but access to skin testing is limited.
Purpose of the Study:
- To assess the safety and feasibility of using an oral amoxicillin challenge without prior skin testing for hospitalized patients with a penicillin allergy label deemed low risk.
Main Methods:
- General medical inpatients with a penicillin allergy label were evaluated.
- Patients assessed as low risk received an oral amoxicillin challenge (250 mg) without preceding skin testing.
- The long-term effectiveness of de-labeling was monitored through clinical record reviews.
Main Results:
- Of 224 patients with a penicillin ADR history, 162 (72%) were classified as low risk.
- 50% of all patients (112 out of 224) had their penicillin allergy label removed.
- 41 out of 79 patients (52%) who underwent the oral amoxicillin challenge tolerated the medication.
Conclusions:
- A thorough adverse drug reaction history is crucial for de-labeling numerous patients.
- Oral amoxicillin challenge without prior skin testing is a safe and practical method for de-labeling low-risk penicillin-allergic patients during hospitalization.
