Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy

JAMA Internal Medicine, Journal Year: 2023, Volume and Issue: 183(9), P. 944 - 944

Published: July 17, 2023

Importance Fewer than 5% of patients labeled with a penicillin allergy are truly allergic. The standard care to remove the label in adults is specialized testing involving prick and intradermal skin followed by an oral challenge penicillin. Skin resource intensive, limits practice specialist-trained physicians, restricts global population who could undergo delabeling. Objective To determine whether direct noninferior low-risk allergy. Design, Setting, Participants This parallel, 2-arm, noninferiority, open-label, multicenter, international randomized clinical trial occurred 6 centers, 3 North America (US Canada) Australia, from June 18, 2021, December 2, 2022. Eligible had PEN-FAST score lower 3. prospectively derived internationally validated decision rule that enables point-of-care risk assessment for reporting allergies. Interventions Patients were randomly assigned either (intervention arm) or standard-of-care arm (control arm). Main Outcome Measure primary outcome was physician-verified positive immune-mediated within 1 hour postintervention intention-to-treat population. Noninferiority achieved if 1-sided 95% CI difference (RD) did not exceed 5 percentage points (pp). Results A total 382 randomized, 377 (median [IQR] age, 51 [35-65] years; 247 [65.5%] female) included analysis: 187 intervention group 190 control group. Most 0 1. patient (0.5%) group, RD 0.0084 pp (90% CI, −1.22 1.24 pp). below noninferiority margin pp. In days following challenge, 9 adverse events recorded 10 (RD, −0.45 pp; −4.87 3.96 No serious occurred. Conclusions Relevance this trial, compared challenge. history, safe procedure facilitate removal label. Trial Registration ClinicalTrials.gov Identifier: NCT04454229

Language: Английский

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Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

Gynecologic Oncology, Journal Year: 2023, Volume and Issue: 173, P. 58 - 67

Published: April 21, 2023

Language: Английский

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Severe cutaneous adverse reactions

Nature Reviews Disease Primers, Journal Year: 2024, Volume and Issue: 10(1)

Published: April 25, 2024

Language: Английский

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Guideline for allergological diagnosis of drug hypersensitivity reactions

Allergologie select, Journal Year: 2023, Volume and Issue: 7(1), P. 122 - 139

Published: Jan. 1, 2023

Not available.

Language: Английский

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Antibiotic Myths for the Infectious Diseases Clinician

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(8), P. 1120 - 1125

Published: June 10, 2023

Antimicrobials are commonly prescribed and often misunderstood. With more than 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious optimal use these drugs is paramount to advancing patient care. This narrative will focus on myths relevant nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety antibiotics.

Language: Английский

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Non–IgE-Mediated Immediate Drug-Induced Hypersensitivity Reactions

The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 12(5), P. 1109 - 1119

Published: Feb. 28, 2024

Language: Английский

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A multicentre observational study to investigate feasibility of a direct oral penicillin challenge in de-labelling ‘low risk’ patients with penicillin allergy by non-allergy healthcare professionals (SPACE study): Implications for healthcare systems

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

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Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(11), P. e2444495 - e2444495

Published: Nov. 4, 2024

Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality evidence. Objective To create a clinical guideline for the diagnosis management urinary tract infections that addresses gap evidence strength. Evidence Review This consensus statement systematic review applied an approach previously established by WikiGuidelines Group construct collaborative guidelines. In May 2023, new existing members were solicited questions on infection prevention, diagnosis, management. For each topic, literature searches conducted up until early 2024 any language. was reported according charter: clear recommendations only when reproducible, prospective, controlled studies provided hypothesis-confirming absence such data, reviews developed discussing available associated risks benefits various approaches. Findings A total 54 representing 12 countries reviewed 914 articles submitted information relevant 5 sections: prophylaxis prevention (7 questions), diagnostic stewardship empirical treatment (3 definitive antimicrobial (10 special populations genitourinary syndromes questions). Of 37 unique questions, could be 6 questions. 3 remaining certain aspects question. Clinical generated not meeting criteria recommendation. Conclusions Relevance this method development, majority topics relating lack high-quality prospective data made. Randomized trials are underway address some these gaps; however further research is utmost importance inform true evidence-based, rather than eminence-based practice.

Language: Английский

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Decisions With Patients, Not for Patients: Shared Decision-Making in Allergy and Immunology

The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 12(10), P. 2625 - 2633

Published: June 6, 2024

Shared decision-making (SDM) is an increasingly implemented patient-centered approach to navigating patient preferences regarding diagnostic and treatment options supported decision-making. This therapeutic prioritizes the patient's perspectives, considering current medical evidence provide a balanced clinical scenarios. In light of numerous recent guideline recommendations that are conditional in nature scenarios defined by preference-sensitive care options, there tremendous opportunity for SDM validated decision aids. Despite expansion literature on SDM, formal acceptance among clinicians remains inconsistent. Surprisingly, significant disparity exists between clinicians' self-reported adherence principles patients' perceptions its implementation during encounters. discrepancy underscores fundamental issue delivery health care, where may overestimate their integration while experiences suggest otherwise. review critically examines factors contributing this inconsistency, including barriers within system, clinician attitudes behaviors, expectations preferences. By elucidating these fields food allergy, asthma, eosinophilic esophagitis, other allergic diseases, aims insights into bridging gap perception experience SDM. Addressing discordance crucial advancing ensuring not merely theoretical concept but tangible reality the.

Language: Английский

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An Economic Evaluation of Direct Oral Penicillin Challenge for De‐Labelling Low Risk Patients With a Penicillin Allergy Label

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

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