Written by Aaron Lacy
In both an outpatient clinic and ICU population, patients deemed to have low risk penicillin allergies who underwent direct oral challenge of amoxicillin had no reported adverse effects.
Why does this matter?
False allergy to penicillin is associated with increased healthcare utilization, surgical site infection, treatment failure for common infections, and negative impact on antimicrobial stewardship. If we are able to remove false allergy listings on patients, this would benefit both patients and our healthcare system.
“I don’t know, I was told I was allergic since I was a kid.”
Between 8-15% of the U.S. population carries a penicillin allergy label, but when allergy tested, less than 5% can be verified. To develop a risk stratification model, 184 patients in an allergy clinic with low risk penicillin allergies (see figure for definition) underwent single dose oral challenge to penicillin, and 100% were asymptomatic. This was then translated to a single center MICU trial that identified 68 patients with low-risk penicillin allergies over a 7-month span, with a total of 58 patients who underwent direct 250mg amoxicillin oral challenge. All patients had no adverse effects and had their penicillin allergy labels removed. One patient later had the allergy reinstated after experiencing nausea and diarrhea after amoxicillin-clavulanate prescription.
This study took place in an allergy clinic and medical ICU, where if a dangerous allergic reaction was to take place, staffing was available with experience in handling allergic complications. However, with 100% of patients in both settings showing no adverse events, I am hopeful that more primary care clinics, even EDs, could implement penicillin oral challenge testing. This could lead to thousands of delisted penicillin allergies, leading to better antibiotic stewardship and patient care in the future.
Risk-Stratified Management to Remove Low-Risk Penicillin Allergy Labels in the Intensive Care Unit. Am J Respir Crit Care Med . 2020 Feb 21. doi: 10.1164/rccm.202001-0089LE. Online ahead of print.
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