Loading...
Direct oral challenge for low-risk penicillin A patients
Samuel, Louise Mohamed, Omar Baretto, Richard Huissoon, Aarnoud Krishna, Mamidipudi T.
Samuel, Louise
Mohamed, Omar
Baretto, Richard
Huissoon, Aarnoud
Krishna, Mamidipudi T.
Citations
Altmetric:
Affiliation
University Hospitals Birmingham NHS Foundation Trust
Other Contributors
Publication date
2024-10-03
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Objective: to review current practice regarding the BSACI guidelines for the set-up of penicillin allergy delabelling services by non-allergists working in a hospital setting in our drug allergy clinic.
Methods
Patients on the drug allergy waiting list waiting for penicillin testing alone were categorised into high and low risk using the criteria in the guidelines.
Low risk patient notes were reviewed for suitability for direct penicillin challenge.
Results
Between January and December 2023, 8 of the 53 waiting list patients were identified as low risk and further patients were identified through new referrals into the allergy department. Forty-three patients in total completed direct penicillin challenges (67% female, age range 17-81 years). Amoxicillin was the drug used in most of the challenges (96%) with co-amoxiclav and flucloxacillin also being used where this had been reported as the index agent.
One patient experienced immediate non-allergic symptoms during the challenge and declined to proceed. The remaining 42 (98%) experienced no immediate symptoms.
Two patients experienced delayed reactions (within 3 days), one (with pre-existing CSU) tested Covid positive and developed urticaria, one mild rash. Both patients were advised to continue to avoid penicillin.
Conclusions
Using the BSACI guidelines for the set-up of penicillin allergy delabelling services by non-allergists working in a hospital setting to guide our practice is feasible and safe, this is demonstrated in the fact that none of our patients experienced immediate symptoms during the procedure.
It is also effective, cost saving (43 direct challenges saved 14 DAP kits for skin testing at a cost of £285 each) and convenient for patients, reducing the need for them to attend 2 appointments to 1 (1 for skin testing and 1 for challenge).
Citation
Samuel, L., Mohamed, O., Baretto, R., Huissoon, A. and Krishna, M.T. (2024) 'Direct oral challenge for low-risk penicillin A patients'. British Society of Allergy and Clinical Immunology (BSACI) Annual Conference. Harrogate, 2-5 October.
Type
Conference Output