BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting.
No Thumbnail Available
Authors
Premchand, Nikhil
Issue Date
2022
Type
Language
Keywords
Alternative Title
Abstract
"The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have devel-oped this guideline for the evaluation and testing of patients with an unsubstanti-ated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de- labelling service for their patients. It is intended to supplement the BSACI 2015 guideline “Management of allergy to penicillin and other beta-lactams” and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients 1136 |SAVICetal.1 | BACKGROUNDA label of penicillin allergy is carried by 5.6% of the general popula-tion, with an estimated 2.7 million people in the UK affected.1 The incidence in hospitalized patients appears to be higher.2,3 About 95% of penicillin allergy labels are incorrect when tested.4,5 Over the past 10 years, the clinical ramifications of a label of “penicillin allergy” have been clearly defined. A diagnosis of penicillin allergy increases the risk of MRSA, C.difficile or VRE infections and death; presumably through increased use of alternatives to beta-lactam antibiotics.1,2,6It increases the duration of hospital admissions and has significant implications for the cost of health care.7,8 The economic impact of penicillin allergy labels has also been elucidated in recent years, with several studies demonstrating the healthcare costs of the label and the economic benefits of removing incorrect labels.9- 11.
Despite this clear association with harm, penicillin allergy test-ing is a scarce resource in the NHS.12 Testing is currently performed by allergists and immunologists working in specialist clinics and is consequently limited to select patient groups (NICE CG 183).13 This model cannot meet either current or future demand and leaves the vast majority of labelled patients unable to access testing. The pro-vision of de-labelling at-scale is therefore only possible with the en-gagement of clinicians who are not trained in allergy or immunology, referred to throughout this document as “non-allergists.”A drug provocation test (DPT) is considered the gold standard test to confirm or refute the diagnosis of allergy in individuals at low risk of an IgE-mediated type 1 immediate hypersensitivity reaction. Current UK and international guidelines for penicillin allergy test-ing recommend the use of skin testing prior to DPT as a means of assessing the likelihood of a positive provocation.14 In recent years, several studies have demonstrated that it is possible to identify patients who are at low risk of penicillin allergy with an allergy history alone.15 - 19 It appears to be safe and efficacious to offer a direct drug provocation test (DPT) without prior skin testing in such patients. The term “direct provocation test” in this guideline refers to the ad-ministration of single or multiple doses of the drug without prior skin testing. In some patients, the allergy history may indicate that there is no increased risk of allergy compared with that of the baseline population risk. In this group, no allergy testing is required before removing the allergy label.with a label of penicillin allergy and does not apply to other beta- lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy"
Description
Citation
Savic, L., Ardern-Jones, M., Avery, A. et al. (2022) BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. Clinical and Experimental Allergy; 52 (10) : 1135-1141.
Publisher
Clinical and Experimental Allergy
License
Journal
Volume
Issue
PubMed ID
ISSN
0954-7894