Review Shares Best Practices for Evaluating Penicillin Allergy
Verifying reported allergies necessary to improve outcomes, prevent antibiotic resistance
WEDNESDAY, Jan. 16, 2019 (Pharmacist's Briefing) -- A new review, published in the Jan. 15 issue of the Journal of the American Medical Association, addresses best practices for the evaluation and management of reported penicillin allergies.
Erica S. Shenoy, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues from the American Academy of Allergy, Asthma & Immunology, the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America conducted a review of the literature and of published professional society guidelines to produce a consensus manuscript.
The authors note that direct amoxicillin challenge is appropriate for patients with low-risk allergy histories, which includes patients having isolated nonallergic symptoms such as gastrointestinal symptoms, patients solely with a family history of a penicillin allergy, patients with symptoms of pruritus without rash, or patients with unknown reactions >10 years ago. Moderate-risk patients, including those with urticaria or other pruritic rashes and reactions with features of Immunoglobulin E-mediated reactions, can be evaluated with penicillin skin testing, which carries a negative predictive value >95 percent and approaches 100 percent when combined with amoxicillin challenge.
"If such allergies are routinely evaluated, patients will not needlessly avoid the beta-lactams that may be the best treatment for their infection and reduce the development of antibiotic resistance," a coauthor said in a statement.
Two authors report copyright on a clinical decision support tool for penicillin allergy evaluation.