Penicillin Allergy De-labelling Ahead of Elective Surgery: Feasibility and Barriers

Savic L, Gurr L, Kaura V et al.

 

Aim of Study

To check the feasibility and barriers towards patients being assessed for and de-labelled as penicillin allergic prior to surgery.

Design and Location

Single-centre, tertiary care setting in the UK, between May 2017 and June 2018.

Methodology

During pre-assessment patients were assessed for eligibility. If deemed to have a low risk history of penicillin allergy they underwent an incremental PO amoxicillin dosing regimen; 10%, 50%, and 100% full dose (500 mg) was used, with 20 min intervals between doses. If no immediate reaction occurred patients took home a 3 day TDS course of 500mg TDS and followed up to check for reactions.

Primary Outcome

To check the feasibility of de-labelling penicillin allergic patients prior to elective surgery.

Secondary Outcomes

Feedback was sought on the experience from patients / patient satisfaction.

Results

219 patients were screened. Of these 74 were deemed eligible for testing.

56 patients deemed suitable and attended testing.

55 of those successfully de-labelled. 1 had lied regarding low risk status to be tested and subsequently had an allergic reaction.

Conclusions/Discussions

1/3 of patients may be suitable for direct oral challenge, that is a low risk history of true penicillin allergy. Of these with a low risk history 100% patients did not have clinically significant reaction when given a direct oral challenge.

Some patients went on to re-label themselves and the reasons for this are unclear.

Stated Limitations from the Study

No limitations stated, however there were perceived barriers to the study. Firstly barrier was a lack of interest in testing. However, patients appeared keen to be tested; leading to an expansion of the inclusion criteria during the study. A second potential barrier was lack of acceptance of the results among clinicians, although the results did not support this.

Discussion from Journal Club Meeting (?Change of Practice)

This study highlights the problem of inappropriate labelling of penicillin allergic during a time when antibiotic resistance is on the increase and the alternative (teicoplanin) has been shown to have a high risk of anaphylaxis.

Currently we do not have capacity, time, funding to run such a programme during pre-assessment.

No one would give penicillin to a patient based on a low risk history alone at present.

Summary by Dr A Burt. Journal Club Meeting 07 February 2019.

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