The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2025, Volume and Issue: 13(5), P. 1027 - 1028
Published: May 1, 2025
Language: Английский
Journal of Infection, Journal Year: 2024, Volume and Issue: 88(3), P. 106116 - 106116
Published: Feb. 6, 2024
ObjectiveThe huge burden of inaccurate penicillin allergy labels (PALs) is an important driver antimicrobial resistance. This magnified by insufficient specialists and lack 'point-of-care' tests. We investigated the feasibility non-allergy healthcare professionals (HCPs) delivering direct oral challenges (DPCs) for de-labelling.MethodsThis prospective observational study was conducted in three hospitals England across settings (acute medical, pre-surgical haematology-oncology). Patients with a PAL were screened stratified as low risk/high risk. Low risk patients (non-immune mediated symptoms, benign rash, tolerated amoxicillin since family history) underwent DPC.ResultsN=2257 PALs screened, 1054 eligible; 643 approached, 373 declined, 270 consented 259 (low risk=155; high risk=104). 126 DPC, 122 (96.8%) de-labelled no serious allergic reactions.Conversion rate from screening-to-consent 12% [3.3% 17.9% acute elective respectively; Odds ratios consent 3.42 (p<0.001) 5.53 haematology-oncology setting respectively. Common reasons failure to progress included difficulty reaching patients, clinical instability/medical reasons, lacking capacity psychological factors.InterpretationDPCs can be delivered HCPs. A proportion did not pathway. Strategies deliver DPC at optimal points care pathway are needed enhance uptake. Elective offer greater opportunities than DPC. The safety simplicity DPCs lends itself adoption systems beyond UK, including resource-limited settings.FundingNIHR129069
Language: Английский
Citations
11
Clinical & Experimental Allergy, Journal Year: 2025, Volume and Issue: unknown
Published: Feb. 5, 2025
ABSTRACT Background Removing inaccurate penicillin allergy labels (PALs) can reduce unnecessary exposure to ‘watch’ and ‘reserve’ groups of antibiotics thereby antimicrobial resistance. The most efficient model for a non‐allergy‐specialist‐led de‐labelling (PADL) service has not been established. Objective To determine the costs UK National Health Service direct oral challenge (DPC) low‐risk patients with PAL in three hospitals England, each different non‐allergy‐specialist delivery model: pharmacist‐led, nurse‐led, mixed multidisciplinary. Methods Cost analysis DPC pathway, including resources related staff time antibiotics. effect on healthcare utilisation over 5 years was modelled using data from published literature. Results In total, 2257 Acute Medical or Infectious Disease Unit (AMU/IDU), Pre‐surgical, Haematology‐Oncology departments were screened. Subsequently, 126 underwent DPC, 122 de‐labelled. Twenty‐two these de‐labelled affect their antibiotic regimen; 6 AMU/IDU 16 Pre‐surgery. represented 22%–23% pathway cost pharmacist‐led models, 15% nurse‐led model. Across per patient varied between £577 (95% Credible Interval: 370, 633) haematology‐oncology £2329 (947, 19,504) patients, both under After years, recouping unlikely any all combined Conclusions ≥ 4‐fold that alone. Costs up 3 times higher an acute compared elective setting. No short‐term savings identified proactive opportunistic this study.
Language: Английский
Citations
1
The Lancet Infectious Diseases, Journal Year: 2025, Volume and Issue: unknown
Published: March 1, 2025
Language: Английский
Citations
1
Intensive Care Medicine, Journal Year: 2024, Volume and Issue: 50(6), P. 913 - 921
Published: May 13, 2024
Critically ill patients are vulnerable to penicillin allergy labels that may be incorrect. The validity of skin testing in intensive care units (ICUs) is uncertain. Many low risk, and validated tools exist identify those amenable direct oral challenge. This pilot randomised controlled trial explored the feasibility, safety, enteral challenge for low-risk critical illness. Consenting with a label (PAL) (PEN-FAST risk assessment score < 3) four ICUs (Melbourne, Australia) were 1:1 (250 mg amoxicillin or implicated penicillin) versus routine (2-h post-randomisation observation each arm). Repeat was performed post -ICU intervention arm. Patients reviewed at 24 h 5 days after challenge/observation. We screened 533 patients. 130 (24.4%) eligible 80/130 (61.5%) enrolled (age median 64.5 years (interquartile range, IQR 53.5, 74), PEN-FAST 1 (IQR 0,1)), 40 (50%) A positive rate 2.5% identified. No antibiotic-associated serious adverse events 32/40 (80%) received repeat (zero positive). Post-randomisation, 13 (32%) arm 4 (10%) control (odds ratio, OR 4.33 [1.27, 14.78] p = 0.019). These findings support validity, feasibility critically assessed allergy. absence false negative results confirmed by subsequent challenges. relatively recruitment ratio suggests more inclusive eligibility criteria integration into ICU processes needed optimise delabelling
Language: Английский
Citations
7
JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(11), P. 1374 - 1374
Published: Sept. 16, 2024
Importance While direct penicillin challenges might support the expansion of allergy delabeling efforts, perceived risk reactions remains a key barrier. Objective To evaluate frequency to in individuals with labels and identify factors associated such reactions. Data Sources Three electronic databases were searched (MEDLINE, Web Science, Scopus) from inception July 19, 2023, for primary studies assessing patients undergoing challenges. Articles included regardless publication year, language, status, or definition risk. Study Selection Two reviewers independently selected original reporting immunologically mediated following challenge allergy. Extraction Synthesis extracted data assessed quality each study using risk-of-bias tool prevalence studies. Main Outcomes Measures The outcome was as calculated random-effects bayesian meta-analysis proportions. Secondary outcomes severe Results A total 56 involving 9225 participants included. Among participants, 438 experienced without prior testing, corresponding an overall meta-analytic 3.5% (95% credible interval [CrI], 2.5%-4.6%). Meta-regression analyses revealed that performed North America had lower rates reaction (odds ratio [OR], 0.36; 95% CrI, 0.20-0.61), while children (OR, 3.37; 1.98-5.98), outpatients 2.19; 1.08-4.75), graded 3.24; 1.50-7.06) prolonged 5.45; 2.38-13.28) higher reaction. Only 5 (3 anaphylaxis, 1 fever rash, acute kidney injury) reported, none which fatal. Conclusions Relevance This systematic review found are infrequent, comparable indirect after testing. These findings suggest safe incorporation into evaluation efforts across age groups clinical settings.
Language: Английский
Citations
7
The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 12(5), P. 1181 - 1191.e10
Published: Jan. 17, 2024
Language: Английский
Citations
5
The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 12(9), P. 2415 - 2426.e1
Published: June 18, 2024
Language: Английский
Citations
5
Allergy, Journal Year: 2024, Volume and Issue: 80(2), P. 525 - 533
Published: Aug. 7, 2024
The consequences of drug allergy remain a global health concern. Drug is often neglected topic and many non-specialists lack sufficient knowledge or confidence in evaluating managing this common condition. Evidence-based interventions to better equip tackle are needed. aim the study evaluate effectiveness an intensive educational course on practice non-specialists. A randomized crossover trial (NCT06399601) was conducted among practicing physicians nurses participating course-Advances Allergy & Penicillin Testing (ADAPT). Participants' baseline self-reported practices were assessed with standardized questionnaires (scored from 0 100, "satisfactory" defined as ≥60/100). Participants into two cohorts attended ADAPT at different time points. Serial responses before after compared within between cohorts. Seventy participants (25 physicians, 45 nurses) groups completed course. Baseline (58.0 ± 19.9) (36.9 24.3) unsatisfactory non-specialists, significantly lower scores than both domains (knowledge: 49.0 17.4 vs. 74.0 12.7; practice: 32.1 21.3 53.3 23.1; all p < 0.001). Following completion ADAPT, demonstrated significant improvements 19.9 77.7 15.9, 0.001) 24.3 71.0 20.2, All (100%) 99% agreed that improved their clinical practice, respectively. effective improving for Further longitudinal studies required long-term impact.
Language: Английский
Citations
5
Current Opinion in Pediatrics, Journal Year: 2024, Volume and Issue: 36(2), P. 144 - 149
Published: Jan. 3, 2024
Purpose of review This is structured to update clinicians on the epidemiology, antibiotic treatment, and prevention pediatric bacterial pneumonia. The provides information regarding current research management for pneumonia newest immunization recommendations prevent pneumococcal other respiratory infections. Recent findings recommended length therapy has been discrepant between low-income high-income countries. Recently, randomized controlled trials conducted in countries provided evidence support a short course (3–5 days) uncomplicated otherwise healthy children. negative impact inaccurate penicillin allergy labels children with emphasized importance prompt de-labeling. Newer vaccines are expected have significant rates. Summary Pediatric an important contributor childhood morbidity mortality. A seems be sufficient outpatient pneumonia; however, more studies required inpatient setting. Future will inform recently introduced syncytial virus epidemiology
Language: Английский
Citations
4
The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 12(11), P. 2985 - 2993
Published: July 20, 2024
Language: Английский
Citations
4