Direct Challenges to Penicillin-Based Antibiotics in the Inpatient Setting.

The Journal of Allergy and Clinical Immunology. in Practice
Allison RamseyMary L Staicu

Abstract

Direct challenge (DC) is an emerging safe and effective alternative to penicillin skin testing (PST) in patients reporting a low-risk reaction history, but limited data exist for the inpatient setting. To demonstrate the safety and efficacy of DC of penicillin-based antibiotics in the inpatient setting in patients with low-risk, cutaneous-only reaction histories more than 20 years ago. Adult inpatients reporting penicillin allergy and receiving antibiotics were screened by an infectious disease PharmD for appropriateness for penicillin allergy delabeling. Patients with low-risk, cutaneous-only reaction histories (rash, hives, itching) more than 20 years ago were offered a 3-step DC. Patients with a cutaneous reaction history less than 20 years ago, a history of angioedema, or reactions involving multiple body systems underwent PST followed by a 1-time observed dose of amoxicillin. A total of 372 patients were screened during the study period, with 100 of these patients undergoing further evaluation, 52 with histories appropriate for PST and 48 with histories appropriate for DC. In the PST group, 44 of 52 (84.6%) patients were PST negative. In the DC group, 47 of 48 (97.9%) patients initially tolerated the DC, with 2 of 48 (4.2%...Continue Reading

Citations

Jul 15, 2020·Expert Review of Anti-infective Therapy·Morgan Thomas RoseJason Trubiano
Sep 30, 2020·Allergy·Adriana ArizaTahia D Fernandez
Oct 10, 2020·Clinica Chimica Acta; International Journal of Clinical Chemistry·Marie-Line M van der PoortenVito Sabato
Mar 20, 2021·Current Allergy and Asthma Reports·Tracy ZemblesDavid Vyles
Apr 4, 2021·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·Jacqueline SneddonR Andrew Seaton
Aug 10, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Melissa IammatteoJean-Christoph Caubet

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