Inpatient Penicillin Allergy Evaluation-Skin Testing Versus Direct Oral Challenge?

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Pharmacology

Background:

• Penicillin allergy labels are frequently applied to patients requiring antibiotics, impacting treatment outcomes and public health.
• Mislabeled allergies can lead to suboptimal antibiotic choices, increasing side effects and antimicrobial resistance, especially in hospitals.

Purpose of the Study:

• To compare the advantages and disadvantages of penicillin skin testing (PST) and direct oral challenge (DOC) for penicillin allergy evaluation in inpatient settings.
• To inform strategies for safe and effective "delabeling" of penicillin allergies to optimize antibiotic stewardship.

Main Methods:

• Review of penicillin allergy evaluation strategies, focusing on penicillin skin testing (PST) and direct oral challenge (DOC).
• Analysis of factors influencing the choice between PST and DOC, including risk stratification, resource availability, and provider/patient comfort.
• Discussion of the pros and cons of each approach in the context of inpatient care.

Main Results:

• Penicillin skin testing (PST) is the historical gold standard, safe for all risk groups but requires specialized training and resources.
• Direct oral challenge (DOC) is simpler and effective for low-risk patients but carries higher risks if patient selection is not precise.
• Both PST and DOC aim to safely "delabel" penicillin allergies but differ in process and limitations.

Conclusions:

• Routine penicillin allergy evaluation is crucial for effective antibiotic stewardship in hospitals.
• The choice between PST and DOC depends on patient risk, available resources, and clinical setting.
• Optimizing penicillin allergy assessment can improve antibiotic prescribing and combat antimicrobial resistance.