unspecified allergy vaccine (Staloral)

Implementation of a Pharmacist-Led Penicillin Allergy Interview at a Veterans Care Facility.

Puckett James Cole JC, Powers Caroline C, Shin Maria M, Larson Robert R

Evaluating a patient's β-lactam allergy involves a thorough review of electronic health records (EHRs), penicillin skin test, and observed oral challenge. The purpose of this study was to evaluate the impact of pharmacist-led penicillin allergy delabeling solely through an interview using the Allergy to β-Lactam Evaluation (ABLE) process. This single-facility, retrospective cohort study reviewed EHR notes. Patient eligibility for allergy profile modifications was determined using guidance from the ABLE process. Interviews were conducted with patients meeting inclusion criteria. A progress note was entered into the EHR following completion of the interview. Patients were compared to a historical control group and matched for allergy severity (immunoglobulin E [IgE]-mediated allergy, unknown, adverse drug reaction [ADR], and severe cutaneous or other non-IgE-mediated reaction). The primary outcome was the number of patient allergy ADRs that were removed or changed on their profile. Six of 35 patients in the interviewed group had allergy profile modifications. The number of patients with a penicillin allergy/ADR modified regardless of change in their antibiotic regimen was statistically higher in the interviewed group compared with the control group: 6 (17.1%) vs 0 (0%) (P < .03). The study findings support the use of the ABLE process for penicillin allergy/ADR modification or clarification. Although the sample size was small, the ABLE process has the ability to positively impact individuals with inappropriate penicillin allergy documentation in the EHR.

Real-Life Application of the Penicillin Allergy Decision Rule (PEN-FAST) Score in De-Labeling Penicillin Allergy: A Case Series.

Begum Fahmida F, Dhlandhlara Takudzwa J TJ, Qazi Nadia N, Ugurlu Aylin A et al.

Penicillin allergies are common but frequently inaccurate, resulting in unnecessary use of broad-spectrum antibiotics and contributing to antibiotic resistance. Tools such as the Penicillin Allergy Decision Rule (PEN-FAST) support the assessment of penicillin allergy risk and can help identify low-risk individuals who may be appropriate candidates for a direct oral penicillin challenge. We report four cases of patients hospitalized with respiratory infections, including infective exacerbation of bronchiectasis, bronchopneumonia, and empyema thoracis, all with documented penicillin allergy labels. In each case, a more detailed review of the allergy history revealed reactions inconsistent with IgE-mediated hypersensitivity reactions, including isolated diarrhea, leg swelling, and delayed rashes. All patients had a PEN-FAST score of 0, which indicated a low risk of a true penicillin allergy. These patients underwent supervised direct oral challenges with amoxicillin or co-amoxiclav, which revealed no adverse reactions. Following a successful oral challenge, penicillin allergies were de-labeled, and the patients were started on optimal antibiotic treatment. All cases revealed favorable outcomes, such as improvements in inflammatory markers and symptoms.

Outcomes From the Use of Cefazolin for Surgical Prophylaxis in Patients Allergic to Penicillin.

Passalacqua Megan M, Knefelkamp Christopher C, Lohmar Haylie H, Kniery Kevin K et al.

For surgical prophylaxis, alternatives to cefazolin are frequently used in patients with penicillin allergy due to the risk of cross-reactivity. This study investigated whether an evidence-based prescribing tool would result in an increased number of patients with a documented penicillin allergy receiving cefazolin for periprocedural antibiotic prophylaxis without an increase in allergic reactions. This single-center, retrospective chart review analyzed patients with a documented penicillin allergy who received periprocedural antibiotics between February 1, 2023, and January 31, 2024. The primary objective was to determine the incidence of allergic reactions in patients with a documented penicillin allergy who received cefazolin perioperatively. Secondary outcomes included the appropriateness of antibiotic regimens in congruence with American System of Health Pharmacists (ASHP) recommendations, incidence of surgical site infections (SSIs), incidence of adverse drug reactions in those with a history of anaphylaxis vs nonanaphylaxis allergy, incidence of allergic reactions requiring interventions, and incidence of acute kidney injury (AKI). There were 197 surgical procedures in patients with a documented penicillin allergy. No allergic reactions were reported. In the cefazolin group, 126 antibiotic regimens (99.2%) were in congruence with ASHP recommendations; all regimens were in congruence with ASHP recommendations in the cefazolin plus gentamicin group; and 58 (86.6%) were in congruence with ASHP recommendations in the other antibiotic group. There was no incidence of SSI in the cefazolin or cefazolin plus gentamicin group, and 3 incidents in the other antibiotic group. One instance of AKI was reported in the cefazolin group, and none were reported in cefazolin plus gentamicin or the other antibiotic group. This study reported similar outcomes to previously published research, which supports the perioperative use of cefazolin in patients allergic to penicillin, including those with a history of anaphylaxis.

Reduced use of skin testing in the evaluation of antibiotic allergy in the United States.

Blumenthal Kimberly G KG, Crawford Renée J RJ, King Andrew J AJ, Khan Daniyal Ali DA et al.