Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline
Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routin...
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| Veröffentlicht in: | Clinical reviews in allergy & immunology 2024-04, Vol.66 (2), p.223-240 |
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| creator | Providencia, Rui Aali, Ghazaleh Zhu, Fang Leas, Brian F. Orrell, Rachel Ahmad, Mahmood Bray, Jonathan J. H. Pelone, Ferruccio Nass, Petra Marijon, Eloi Cassandra, Miryan Celermajer, David S. Shokraneh, Farhad |
| description | Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine penicillin allergy testing and the (ii) safety of penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low ( |
| doi_str_mv | 10.1007/s12016-024-08988-2 |
| format | Article |
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P
< 0.00001,
I
2
= 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of penicillin allergy diagnosis or delabeling using direct oral drug challenge or penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.</description><identifier>ISSN: 1559-0267</identifier><identifier>ISSN: 1080-0549</identifier><identifier>EISSN: 1559-0267</identifier><identifier>DOI: 10.1007/s12016-024-08988-2</identifier><identifier>PMID: 38696031</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Allergies ; Allergology ; Anaphylaxis ; Anti-Bacterial Agents - adverse effects ; Drug Hypersensitivity - diagnosis ; Drug Hypersensitivity - epidemiology ; Heart diseases ; Humans ; Immunology ; Internal Medicine ; Medical personnel ; Medicine ; Medicine & Public Health ; Oral administration ; Penicillin ; Penicillins - adverse effects ; Practice Guidelines as Topic ; Review ; Rheumatic fever ; Rheumatic heart disease ; Skin Tests ; World Health Organization</subject><ispartof>Clinical reviews in allergy & immunology, 2024-04, Vol.66 (2), p.223-240</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-82951260f2433bd35bb04c327b405430e73315286e053d868b526f37a0eee49d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12016-024-08988-2$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12016-024-08988-2$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,777,781,882,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38696031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Providencia, Rui</creatorcontrib><creatorcontrib>Aali, Ghazaleh</creatorcontrib><creatorcontrib>Zhu, Fang</creatorcontrib><creatorcontrib>Leas, Brian F.</creatorcontrib><creatorcontrib>Orrell, Rachel</creatorcontrib><creatorcontrib>Ahmad, Mahmood</creatorcontrib><creatorcontrib>Bray, Jonathan J. H.</creatorcontrib><creatorcontrib>Pelone, Ferruccio</creatorcontrib><creatorcontrib>Nass, Petra</creatorcontrib><creatorcontrib>Marijon, Eloi</creatorcontrib><creatorcontrib>Cassandra, Miryan</creatorcontrib><creatorcontrib>Celermajer, David S.</creatorcontrib><creatorcontrib>Shokraneh, Farhad</creatorcontrib><title>Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline</title><title>Clinical reviews in allergy & immunology</title><addtitle>Clinic Rev Allerg Immunol</addtitle><addtitle>Clin Rev Allergy Immunol</addtitle><description>Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine penicillin allergy testing and the (ii) safety of penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low (< 1–3/1000 individuals treated). A subsequent search addressed penicillin allergy delabeling. This found 516 records, and 5 studies addressing the safety of direct oral drug challenge vs. skin testing followed by drug administration in patients with suspected penicillin allergy. Immediate allergic reactions of minor severity were observed for a minority of patients and occurred less frequently in the direct drug challenge group: 2.3% vs. 11.5%; RR = 0.25, 95%CI 0.15–0.45,
P
< 0.00001,
I
2
= 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of penicillin allergy diagnosis or delabeling using direct oral drug challenge or penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.</description><subject>Allergies</subject><subject>Allergology</subject><subject>Anaphylaxis</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Drug Hypersensitivity - diagnosis</subject><subject>Drug Hypersensitivity - epidemiology</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Immunology</subject><subject>Internal Medicine</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oral administration</subject><subject>Penicillin</subject><subject>Penicillins - adverse effects</subject><subject>Practice Guidelines as Topic</subject><subject>Review</subject><subject>Rheumatic fever</subject><subject>Rheumatic heart disease</subject><subject>Skin Tests</subject><subject>World Health Organization</subject><issn>1559-0267</issn><issn>1080-0549</issn><issn>1559-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEoqXwAiyQJTZsUq7txHHYoFGBFqlSR1DUpeUkNxlXHru1k6LhNXjhOp3Sli668s_97rk-Pln2lsI-Bag-RsqAihxYkYOspczZs2yXlmWdrkT1_MF-J3sV4zkAA8nrl9kOl6IWwOlu9neJzrTGWuPIwloMw4acYhyNG4h2HfmCVjdo52PvA1nq0aAbIzlbebIISJYBYxtMgx25V_pEFuTnJo64TnhLfuCVwd83_Zqc-WA7coTajityEgbtzJ9EeUcOJ9PNk_B19qLXNuKb23Uv-_Xt6-nBUX58cvj9YHGctwUTYy5ZXVImoGcF503Hy6aBouWsagooCw5YcU5LJgVCyTspZFMy0fNKAyIWdcf3ss9b3YupWWPXJmNBW3URzFqHjfLaqP8rzqzU4K8UpbTmkouk8OFWIfjLKX2bWpvYorXaoZ-i4lACrSpZz-j7R-i5n4JL_hJVUcopLVii2JZqg48xYH_3GgpqDl1tQ1cpdHUTupqb3j30cdfyL-UE8C0QU8kNGO5nPyF7DV7NuFs</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Providencia, Rui</creator><creator>Aali, Ghazaleh</creator><creator>Zhu, Fang</creator><creator>Leas, Brian F.</creator><creator>Orrell, Rachel</creator><creator>Ahmad, Mahmood</creator><creator>Bray, Jonathan J. 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H.</creatorcontrib><creatorcontrib>Pelone, Ferruccio</creatorcontrib><creatorcontrib>Nass, Petra</creatorcontrib><creatorcontrib>Marijon, Eloi</creatorcontrib><creatorcontrib>Cassandra, Miryan</creatorcontrib><creatorcontrib>Celermajer, David S.</creatorcontrib><creatorcontrib>Shokraneh, Farhad</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical reviews in allergy & immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Providencia, Rui</au><au>Aali, Ghazaleh</au><au>Zhu, Fang</au><au>Leas, Brian F.</au><au>Orrell, Rachel</au><au>Ahmad, Mahmood</au><au>Bray, Jonathan J. 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Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine penicillin allergy testing and the (ii) safety of penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low (< 1–3/1000 individuals treated). A subsequent search addressed penicillin allergy delabeling. This found 516 records, and 5 studies addressing the safety of direct oral drug challenge vs. skin testing followed by drug administration in patients with suspected penicillin allergy. Immediate allergic reactions of minor severity were observed for a minority of patients and occurred less frequently in the direct drug challenge group: 2.3% vs. 11.5%; RR = 0.25, 95%CI 0.15–0.45,
P
< 0.00001,
I
2
= 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of penicillin allergy diagnosis or delabeling using direct oral drug challenge or penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38696031</pmid><doi>10.1007/s12016-024-08988-2</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical reviews in allergy & immunology, 2024-04, Vol.66 (2), p.223-240 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Allergies Allergology Anaphylaxis Anti-Bacterial Agents - adverse effects Drug Hypersensitivity - diagnosis Drug Hypersensitivity - epidemiology Heart diseases Humans Immunology Internal Medicine Medical personnel Medicine Medicine & Public Health Oral administration Penicillin Penicillins - adverse effects Practice Guidelines as Topic Review Rheumatic fever Rheumatic heart disease Skin Tests World Health Organization |
| title | Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline |
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