Materiały źródłowe

• #1 Penicillin allergy: Definition, treatment, and more

  https://www.medicalnewstoday.com/articles/penicillin-allergy

  A penicillin allergy can cause symptoms such as hives, shortness of breath, and areas of swelling. […] People with penicillin allergies may safely get the COVID-19 vaccine, but someone should observe them for 30 minutes afterward. […] According to the American Academy of Allergy, Asthma Immunology, although 10% of the population report a penicillin allergy, more than 90% have negative allergy testing and can take penicillin and related antibiotics without symptoms. […] If a person has a penicillin allergy, even a severe one, health authorities do not prohibit them from getting the mRNA SARS-CoV-2 vaccine. […] The following classes of antibiotics are alternatives to penicillins: tetracyclines, macrolides, glycopeptides, quinolones, aminoglycosides, cephalosporins. […] If their allergic response indicates an IgE-mediated reaction, desensitization might be an option. […] Doctors would not recommend desensitization for any allergy that is not IgE mediated, regardless of severity, as desensitization is only known to work in IgE-mediated allergies.

• #2 Penicillin Allergy Delabeling | Washington State Department of Health

  https://doh.wa.gov/penicillin-allergy-delabeling

  Studies actually show that less than 1% of the population is truly allergic to penicillin. […] Penicillin and other similar antibiotics often work better for certain infections (i.e., antibiotics given before surgery or dental procedures). People who report a penicillin allergy often receive other antibiotics that cause more side effects. If your health care provider discovers that you do not have a true penicillin allergy, they will have more options to treat your bacterial infection. […] Make sure youre getting the best antibiotic for your infection. Talk to your health care provider today about your penicillin allergy.

• #3 National Penicillin Allergy Day – NPAD

  https://nationalpenicillinallergyday.com/

  Unverified penicillin allergy is being increasingly recognized as a public health concern. […] Studies have found that an estimated 10% of patients self-report as being penicillin allergic, but only 1% are actually allergic. […] Correctly identifying those who are not actually allergic can improve antibiotic prescribing and combat the risk of super-bugs by allowing patients access to safer, less toxic antibiotics. […] There is a causal relationship between inappropriate antimicrobial use and resistance; changes in antimicrobial use lead to parallel changes in the prevalence of resistance.

• #4 Mayo Clinic Health Library – Penicillin allergy | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20376207

  If you have a penicillin allergy, the simplest prevention is to avoid the drug. Steps you can take to protect yourself include the following: […] Inform health care workers. Be sure that your penicillin allergy or other antibiotic allergy is clearly identified in your medical records. Inform other health care professionals, such as your dentist or any medical specialist. […] Wear a bracelet. Wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency.

• #5

  https://www.wyndly.com/blogs/learn/penicillin-allergy?srsltid=AfmBOoqQxWdwX2bn0xPPcLXFDcGlKJpEJ7ccUJxqHj7ejQ-5pmZPPdis

  How Can Penicillin Allergy Be Prevented? […] Preventing a penicillin allergy is challenging, as it’s often unpredictable and can occur even if you’ve taken the medication before with no issues. However, there are strategies that can reduce the risk or manage a known allergy. […] Ensure that penicillin and other antibiotics are used correctly. This includes only using them when necessary and completing the full course of treatment, even if symptoms improve before the medication is finished. […] If you have a known penicillin allergy, inform all healthcare providers, including dentists and pharmacists. They can then prescribe alternative medications when necessary. […] Consider wearing a medical alert bracelet that clearly indicates your allergy. This can provide critical information to healthcare professionals in case of an emergency.

• #6

  https://www.wyndly.com/blogs/learn/penicillin-allergy?srsltid=AfmBOoqQxWdwX2bn0xPPcLXFDcGlKJpEJ7ccUJxqHj7ejQ-5pmZPPdis

  Always read the labels of over-the-counter (OTC) medications. Some OTC drugs may contain penicillin or other antibiotics. […] Remember, while there’s no surefire way to prevent a penicillin allergy, these steps can help manage risks associated with the allergy. If you suspect a penicillin allergy, consult a healthcare provider for an appropriate allergy test.

• #7 Penicillin Allergy — Who Should Be Tested and Why? | Atlanta Allergy & Asthma

  https://www.atlantaallergy.com/articles/view/261-penicillin-allergy–who-should-be-tested-and-why

  True penicillin allergy is serious, even life-threatening. Someone with a confirmed penicillin allergy should avoid the entire medication group which includes 15 chemically related drugs. Ask your physician if you should be prescribed injectable epinephrine, the only treatment that will stop anaphylaxis, a severe, potentially fatal, allergic reaction. […] Penicillin allergy testing is safe and reliable. The patient undergoes a series of skin prick tests with gradually increased amounts of penicillin. A raised bump, or wheal, at the site of the prick, indicates the allergy. If the tests are negative, the next step is an oral challenge to confirm the patient can safely take this drug. These tests should always be conducted by a board-certified allergist trained to recognize and treat potential allergic reactions.

• #8 Is It a Penicillin Allergy or Not? An Education Pilot Program

  https://www.infectiousdiseaseadvisor.com/features/penicillin-allergy-educational-pilot-program/

  Although 33 million individuals in the US have a documented penicillin allergy, greater than 95% of these patients can tolerate -lactam drugs. The unnecessary use of alternative antibiotics in patients with penicillin allergies is associated with higher health care costs, increased risk of antibiotic resistance, and suboptimal antibiotic therapy, according to the CDC. […] The evaluation and removal of the penicillin allergy label from the chart of patients without a true allergy will facilitate the use of less expensive medications. […] Educational sessions were used as an initial approach to inform providers on how to appropriately identify and select antibiotics for patients that could lead to increased use of first-line penicillin and a decrease in antibiotic resistance. […] The review identified the need to increase penicillin allergy awareness and education among providers and prescribers. Effectively informing providers in the community about appropriate antibiotic prescribing is one aspect of improving awareness.

• #9

  https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/penhypers.htm

  The phrase allergic to penicillin is commonly seen in medical notes and on medicine charts. The diagnosis of penicillin allergy is often simply accepted without obtaining a detailed history of the reaction. It has been reported that a significant percentage of patients labelled as penicillin allergic are not truly allergic to the drug. As a result, penicillins are unnecessarily withheld from these patients, which may subsequently affect their clinical outcomes. […] Individuals with a history of Type I allergy clinically recognisable by features of urticaria, laryngeal oedema, bronchospasm, hypotension or local swelling within 72 hours of administration, or development of a pruritic rash (even after 72 hours) should NOT receive a penicillin. […] Patients with no evidence of Type I allergy to penicillin may be treated with any cephalosporin or beta lactam antibiotic for infections of any severity. Patients with symptoms suggestive of a Type I allergy should avoid cephalosporins and other beta-lactam antibiotics for mild or moderate infections when a suitable alternative exists. In life threatening infections, when use of a non-cephalosporin antibiotic would be sub-optimal, consider giving, under observation, a second or third generation cephalosporin (e.g. cefuroxime, ceftriaxone, ceftazidime). If necessary seek advice from ID or Microbiology. […] Always identify and document the nature of the reported allergy and drug name on the medicine chart and in the medical notes. The prescriber has the primary responsibility for ensuring that the allergy/sensitivity details are completed on all relevant medicine charts and medical notes.

• #10 Galway Antimicrobial Prescribing Policy / Guidelines (GAPP) – Galway: GAPP

  https://eguides.megsupporttools.com/public/guh/penicillin-hypersensitivity/?view=menu

  For the purposes of prescribing in penicillin allergy it is important to differentiate between an immediate hypersensitivity reaction, a severe delayed hypersensitivity reaction and a non-severe delayed hypersensitivity reaction. […] Patients with a history of immediate (within one hour) hypersensitivity reaction (anaphylaxis, laryngeal oedema, bronchospasm, hypotension, local swelling, urticaria or pruritic rash) should not receive a penicillin, cephalosporin or carbapenem (e.g. meropenem). […] Patients with a history of severe delayed hypersensitivity reaction (SJS, TEN, DRESS, AGEP) to penicillin should not receive any beta-lactam consultation with Immunology/Dermatology advised. […] The Penicillin Allergy Traffic Light Poster lists antibiotics that are contraindicated, can be used with caution and are considered safe to use in penicillin allergy.

• #11 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Evaluating a patient who reports a penicillin or another -lactam antibiotic allergy involves three steps: 1) obtaining a thorough medical history, including previous exposures to penicillin or other -lactam antibiotics; 2) performing a skin test evaluation by using the penicillin major and minor determinants; and 3) among those who have a negative penicillin skin test, performing an observed oral challenge with 250 mg amoxicillin before proceeding directly to treatment with the indicated -lactam therapy. […] For persons who have a positive skin test reactive to penicillin (either to the major or minor determinants), treatment with a -lactam antibiotic is not usually advised, and other effective antimicrobials should be used. […] Desensitization protocols to penicillin should be performed by allergists, and they require a monitored inpatient environment.

• #11 Penicillin Allergy – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/penicillin-allergy.htm

  Skin testing for penicillin allergy should be performed if any indication exists that the symptoms were secondary to an IgE-mediated hypersensitivity. […] Testing is also indicated as a potential diagnostic procedure to definitively rule out penicillin allergy and document a negative allergy status in the medical record (i.e., delabeling). […] Persons with negative results of a penicillin skin test, followed by an amoxicillin oral challenge, can receive conventional penicillin therapy safely if needed. […] Desensitization is required for persons who have a documented penicillin allergy and for whom no therapeutic alternatives exist (e.g., syphilis during pregnancy and persons with neurosyphilis). […] Programs should identify local allergy consultant resources.

• #12 Management of Penicillin Allergy in the Perioperative Setting

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10886174/

  The selection of perioperative antibiotic prophylaxis is challenging in patients with a history of penicillin allergy; as such, we present a literature review exploring current best practices and the associated supporting evidence, as well as areas for future research. […] Guidelines recommend the use of alternative agents in patients with an IgE-mediated hypersensitivity reaction, but those alternative agents are associated with worse outcomes, including an increased risk of surgical site infection, and higher cost. […] More recent data suggest that the risk of cross-reactivity between penicillins and cephalosporins, particularly cefazolin, is extremely low, and that cefazolin can be used safely in most penicillin-allergic patients. […] A variety of interventions, including preoperative allergy de-labeling with incorporation of penicillin skin testing, use of patient risk-stratification questionnaires, and utilization of clinician algorithms to guide antibiotic selection intraoperatively, have all been shown to significantly increase cefazolin utilization without a corresponding increase in adverse events.

• #13 Management of Penicillin Allergy in the Perioperative Setting

  https://www.mdpi.com/2079-6382/13/2/157

  Cefazolin is often avoided in surgical patients with a PAL for fear of cross-reactivity, despite true penicillin hypersensitivity being rare (<5%) in patients with a PAL, and an extremely low likelihood of cross-reactivity between penicillins and cephalosporins (1–2%). [...] Understanding the immunogenic components of beta-lactams may clarify why the cross-reactivity rate between penicillin and cephalosporins is negligible. [...] Cefazolin thus should be safe for administration in most patients with penicillin or other cephalosporin allergies. [...] The negligible cross-reactivity between cefazolin and penicillins is reflected in the drug allergy practice parameters issued jointly by the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Asthma, Allergy and Immunology (ACAAI).

• #14 Pre-Operative Management of the Penicillin Allergic Patient: A Narrative Review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/124336-pre-operative-management-of-the-penicillin-allergic-patient-a-narrative-review

  Penicillin is a frequently reported medication allergy. The beta-lactam ring shared between cephalosporins and penicillin often leads to the use of alternative antibiotics for surgical prophylaxis due to concern for cross-reactivity, despite a true IgE-mediated hypersensitivity being very rare. […] Preoperative penicillin allergy testing has been demonstrated to be a cost-effective measure in the prevention of prosthetic joint infection and is suggested for all penicillin-allergic patients in the peri-operative setting. […] A penicillin allergy has been associated with increased risk of orthopaedic postoperative infection which is attributed to the use of less efficacious antibiotics such as clindamycin and vancomycin. […] Preoperative penicillin allergy testing has been demonstrated to be a cost-effective measure in the prevention of prosthetic joint infection and is recommended for all penicillin-allergic patients in the peri-operative setting.

• #15 Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38527607/

  Cefazolin is the most common antibiotic used for prophylaxis in obstetrics and gynecology. Among those with a penicillin allergy, alternative antibiotics are often chosen for prophylaxis, given fears of cross-reactivity between penicillin and cefazolin. […] Given the difference in R1 side chains between penicillin and cefazolin, cefazolin use is safe and should be recommended for patients with a penicillin allergy, including those who experience Immunoglobulin E-mediated reactions such as anaphylaxis. […] Increased referral for penicillin allergy testing should be incorporated into routine obstetric care and preoperative assessment to reduce suboptimal antibiotic prophylaxis use. More education is needed among providers surrounding penicillin allergy assessment and cross-reactivity among penicillins and cephalosporins to optimize antibiotic prophylaxis in obstetrics and gynecology.

• #16 Management of Penicillin Allergy in the Perioperative Setting

  https://www.mdpi.com/2079-6382/13/2/157

  Their 2022 updated guidelines recommend the administration of cefazolin to most penicillin-allergic patients, including both those with a history of IgE-mediated reactions including anaphylaxis, and those with a non-anaphylactic reaction to penicillin. […] However, this recommendation does not apply to patients with histories of severe delayed, presumably T-cell-mediated, immune reactions. […] Based on this emerging evidence, surgical programs have explored how best to design and implement new guidelines and educate proceduralists, in order to encourage cefazolin use in appropriate patients with a PAL. […] Studies have evaluated opportunities to clear allergy labels at pre-procedure appointments, as well as algorithms for assessing cefazolin safety at the time of surgery. […] One strategy to promote cefazolin use in surgical patients with a PAL has been through preliminary penicillin skin testing (PST).

• #17 Best Approach When Pregnant Women Report Penicillin Allergies?

  https://www.uspharmacist.com/article/best-approach-when-pregnant-women-report-penicillin-allergies

  For this reason, ACOG has recommended penicillin allergy testing for pregnant women who report a penicillin or amoxicillin allergy. […] Past research has found penicillin allergy testing to be cost saving, with a net benefit ranging from $256 to $6,745 for inpatients and outpatients, respectively.

• #17 Best Approach When Pregnant Women Report Penicillin Allergies?

  https://www.uspharmacist.com/article/best-approach-when-pregnant-women-report-penicillin-allergies

  Penicillin allergy actually is rare, despite the frequency of reporting. […] The issue is especially significant in pregnancy, wrote Mayo Clinicled researchers. Penicillin is the agent of choice for intrapartum antibiotic prophylaxis to reduce the risk of group B streptococcus [GBS] early-onset disease in the newborn, they noted. […] Penicillin allergy testing has been found to be safe in pregnancy and cost-effective in other patient populations. […] Our results show that a test then treat strategy for pregnant women who report a penicillin allergy is a good-value intervention, the researcher pointed out. […] The authors argued that it is important to investigate claims of antibiotic allergies because, when reported adverse reactions to antibiotics are not explored by prescribing providers, it often results in the use of alternative broader spectrum treatment than is required.

• #18 Best Approach When Pregnant Women Report Penicillin Allergies?

  https://www.uspharmacist.com/article/best-approach-when-pregnant-women-report-penicillin-allergies

  An alternative antibiotic to penicillin includes first-generation cephalosporins such as cefazolin for women with a low-risk penicillin allergy, the study advised. […] When a GBS isolate is not susceptible to clindamycin, vancomycin is the only validated option for intrapartum prophylaxis in patients with a penicillin allergy. […] Taking into account the significant morbidity and mortality associated with neonatal GBS infection, the CDC and American College of Obstetricians and Gynecologists (ACOG) recommended universal culture-based GBS screening for all prenatal patients aged between 36 0/7 and 37 6/7 weeks of gestation. […] GBS remains susceptible to both penicillin and ampicillin, and penicillin is the treatment of choice for GBS infections and prophylaxis because of its low cost, effectiveness, and narrow antimicrobial spectrum, according to the researchers.

• #19 Antibiotics: What Is Preferred for Penicillin-allergic Orthopedic Patients? | Wolters Kluwer

  https://www.wolterskluwer.com/en/expert-insights/antibiotics-what-is-preferred-for-penicillin-allergic-orthopedic-patients

  The American Academy of Orthopedic Surgeons (AAOS) has historically recommended antibiotic premedication in select patients with hip or knee implants undergoing medical or dental procedures that produce bacteremia. […] In penicillin-allergic patients, clindamycin has historically been the recommended optional drug because it is believed to have little or no cross-allergenicity with penicillin. […] More recently, however, the AAOS is now recommending a cephalosporin rather than clindamycin in penicillin-allergic patients. […] One of the AUC for the penicillin-allergic patient undergoing dental procedures resulting in bacteremia is 2 g cephalexin or 500 mg of azithromycin or clarithromycin, in that order. […] According to the AAOS, with reference to an article on Beta-lactam hypersensitivity and cross-reactivity by Terico and Gallagher, cross-reactivity of the cephalosporin antibiotics in patients with penicillin allergy is 5% for first-generation drugs and 1% for third-generation drugs.

• #20 Penicillin Allergy Assessment Tool Kit | Carolina Antimicrobial Stewardship Program

  https://www.med.unc.edu/casp/educational-resources/penicillin-allergy-assessment-tool-kit/

  Penicillin allergy assessments have been expanded to the inpatient areas of UNC Medical Center. […] These allergies can be evaluated by a trained pharmacist or physician. The outpatient tool kit below has been created to educate patients and their caregivers and to train healthcare providers on how to assess penicillin allergies proactively. Removing the allergy from medical records of patients who are not truly allergic to penicillins is an important stewardship tool that decreases unnecessary use of broad-spectrum antibiotics. […] The Penicillin Allergy Assessment Tool Kit is a collaboration of the UNC Medical Centers Carolina Antimicrobial Stewardship Program, the UNC Division of Rheumatology, Allergy Immunology, and the UNC Institute for Healthcare Quality Improvement. If you are interested in incorporating penicillin allergy assessments into your practice, please contact Mildred Kwan for more information.

• #21 PEN-FAST Forward: Accelerating Penicillin Allergy De-Labeling

  https://www.contagionlive.com/view/pen-fast-forward-accelerating-penicillin-allergy-de-labeling

  PEN-FAST is a validated risk stratification tool that promotes efficient, safe, and effective de-labeling of penicillin allergies. […] De-labeling previous penicillin allergies can aid in improving patient outcomes, as well as improve stewardship efforts. […] The American Academy of Allergy, Asthma, and Immunology (AAAAI) endorses proactive penicillin allergy de-labeling efforts. […] No matter what de-labeling strategy is employed, it is important to get a thorough and accurate allergy history, including the type of reaction, timing of reaction, any treatment received for the reaction, and antibiotics the patient has tolerated since the reaction. […] In patients who have reactions that are more consistent with intolerance than allergy, AAAAI recommends the removal of a penicillin allergy label without any additional testing.

• #22 Guidelines for Antibiotic Allergy with special reference to Penicillin and Beta Lactam Allergy

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/drug-interactions/guidelines-for-antibiotic-allergy-with-special-reference-to-penicillin-and-beta-lactam-allergy.html

  Do not administer Penicillin, unless or until further evaluated. […] Future use of Penicillin is NOT usually contraindicated in this group. […] If uncertain, discuss with a Specialist in Immunology / Allergy or with a Paediatrician with a special interest in allergy. […] Patients with true Penicillin Allergy should be informed of their sensitivity, the necessity for avoidance and the importance of advising all future healthcare personnel of the sensitivity. […] Desensitisation of Penicillin Allergic patients is a high risk procedure and should be reserved for serious acute clinical situations where no other antibiotic choice exists and where personnel and resources to manage same are present.

• #23

  https://ronlitman.substack.com/p/leveraging-quality-improvement-to

  There are many old wives tales (bubba meisas) that have serious implications in how we practice pediatric anesthesia, like the avoidance of cephalosporins for surgical site infection prophylaxis in penicillin allergic patients. […] Patients are not receiving appropriate first-line surgical antibiotic prophylaxis due to fear of an allergic cross reaction. […] A comprehensive and multifaceted approach is needed to increase use of first-line SAP in patients with a reported penicillin allergy in an effort to decrease the risk of SSIs. […] The team implemented a collaborative, multifaceted strategy involving surgery, nurse practitioners, and pharmacy, utilizing the Institute for Healthcare Improvement quality improvement methodology. […] Key interventions included: Education: Providing training for surgeons, anesthesiologists, nurse practitioners, and perioperative staff.

• #24

  https://ronlitman.substack.com/p/leveraging-quality-improvement-to

  Additionally, a screening process was established to identify patients who genuinely need to avoid cephalosporins. […] The percentage of penicillin-allergic patients receiving first-line antibiotics rose from 25% to 84%. […] No adverse reactions were reported. […] The approach outlined in this paper provides a structured method for managing patients with penicillin allergies. […] Successful Improvement necessitates education, standardization, transparency, and EMR modifications. […] Continuous monitoring is essential for maintaining improvements.

• #25 Allergic to Penicillin? You Might Not Be. | Summit Health

  https://www.summithealth.com/health-wellness/allergic-penicillin-you-might-not-be

  Talk to your provider if youre unsure whether you have a true penicillin allergy. Better yet, ask to see an allergist for penicillin allergy testing. During your initial consultation, your allergist will determine the most appropriate testing strategy. An oral drug challenge may eventually be conducted at some point to confirm that you can now tolerate penicillin. […] If you think you may have a penicillin allergy, make an appointment with an allergist at Summit Health. Tests are available and can determine if you still have an allergy.

• #26 Penicillin Allergy Delabeling | Washington State Department of Health

  https://doh.wa.gov/public-health-provider-resources/healthcare-professions-and-facilities/healthcare-associated-infections/antimicrobial-resistance-and-antimicrobial-stewardship/antibiotic-stewardship/penicillin-allergy-delabeling

  According to United States Centers for Disease Control, approximately 10% of all US patients report having an allergic reaction to a penicillin class antibiotic in their past. When evaluated, however, fewer than 1% of the population are found to be truly allergic. […] These educational resources are intended to be given to eligible patients by health care providers. […] Desensitization is intended for patients who have a moderate to high risk of severe allergy needing urgent treatment with penicillins (e.g., treatment of syphilis with a confirmed penicillin allergy). […] Desensitization and de-labeling are separate processes. See General Education Resources for patient education for penicillin allergy de-labeling. […] AAAIs Drug Allergy Guideline Provides guidance for penicillin and beta-lactam allergy delabeling efforts. […] CDCs Is It Really a Penicillin Allergy? Contains education and questions to ask of a patient to evaluate a penicillin allergy.

• #27 Penicillin Allergy Management – Removing Barriers to Optimal Antibiotic Prescribing | LearningCE @ SHEA

  https://learningce.shea-online.org/content/penicillin-allergy-management-removing-barriers-optimal-antibiotic-prescribing

  In current practice, penicillin allergy labels are largely unevaluated and untested. Penicillin allergy labels present a barrier to optimal antibiotic prescribing. […] After an evaluation, most such labels will be low risk and can be safely challenged with a dose of amoxicillin to disprove and remove the allergy. […] Recognize the importance of a patient’s penicillin allergy risk assessment in guiding testing decisions and determining the suitability of prescribing cephalosporin antibiotics. […] Demonstrate the ability to conduct an amoxicillin challenge for patients with low-risk penicillin allergies. […] Define the importance of penicillin allergy skin testing as a preliminary assessment for higher-risk patients before challenges. […] Identify the significance of avoiding beta-lactams in cases of severe delayed allergic reactions and provide a descriptive understanding of appropriate strategies for patient care.

• #28 Galway Antimicrobial Prescribing Policy / Guidelines (GAPP) – Galway: GAPP

  https://eguides.megsupporttools.com/public/guh/penicillin-hypersensitivity/?view=menu

  Refer people with a suspected allergy to beta-lactam antibiotics to Immunology if they need treatment for a condition that can only be treated by a beta-lactam antibiotic or are likely to need beta-lactam antibiotics frequently in the future (e.g. those with anatomical predisposition to infections or immunodeficiency).

• #29 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns

  INTERIM UPDATE: The content in this Committee Opinion has been updated as highlighted (or removed as necessary) to reflect a limited, focused change in the language regarding penicillin allergy testing, categories for penicillin (ie, low-risk and high-risk of anaphylaxis or severe reaction) ( Table 2), and penicillin dose ( Figure 3). […] Alternatively, penicillin allergy testing, if available, is safe during pregnancy and can be beneficial for all women who report a penicillin allergy, particularly those that are suggestive of being IgE mediated, or of unknown severity, or both. Ascertaining the absence of a type I hypersensitivity reaction will eliminate the need to use alternatives to penicillin for GBS EOD prophylaxis and provide long-term benefit if treatment with beta-lactam antibiotics is indicated in their future health care management.

• #30 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns

  For women who are at high risk of anaphylaxis after exposure to penicillin, the laboratory requisitions for ordering antepartum GBS screening cultures (whether on paper or online in electronic medical records) should indicate clearly the presence of penicillin allergy. This step is intended to ensure that the need to test GBS isolates for clindamycin susceptibility is recognized and performed by laboratory personnel, and that the health care provider understands the importance of reviewing such a test result. […] For women with a high risk of anaphylaxis or severe rare delayed-onset (non-IgE mediated) reaction, clindamycin is the recommended alternative to penicillin only if the GBS isolate is known to be susceptible to clindamycin because rates of resistance approach 20% or greater. […] Intravenous vancomycin remains the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis for women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin.

• #31 Clinical Features of Penicillin Allergy | Antibiotic Prescribing and Use | CDC

  https://www.cdc.gov/antibiotic-use/hcp/clinical-signs/index.html

  Conduct a history and physical exam to confirm a true penicillin allergy (and when appropriate, skin test and challenge dose) before prescribing broad-spectrum antibiotics to a patient thought to be penicillin-allergic. […] Correctly identifying those who are not truly penicillin-allergic can decrease unnecessary use of broad-spectrum antibiotics. […] Penicillin skin testing and challenge doses are reliable and useful methods for evaluating for IgE-mediated penicillin allergy. […] A positive result means the patient is likely to have a penicillin allergy. If negative, a skin test is usually followed by an oral penicillin class challenge (like amoxicillin) to safely rule out an IgE-mediated penicillin allergy. […] The skin test and challenge described here are not appropriate for patients with these severe hypersensitivity syndromes. […] Correctly identifying if your patient is actually penicillin-allergic can decrease these risks by reducing unnecessary use of broad-spectrum antibiotics.

• #32 Most Patients with a “Penicillin Allergy Label” Can Safely Take Penicillin | AAFP

  https://www.aafp.org/pubs/afp/afp-community-blog/entry/most-patients-with-a-penicillin-allergy-label-can-safely-take-penicillin.html

  Most people who report a penicillin allergy were told they had a reaction as an infant or young child (typically a rash), assumed they had an allergy because a family member did, and/or experienced adverse effects (such as nausea) that are not IgE-mediated. […] A good history can remove penicillin allergies from the charts of patients with adverse effects (not allergy) and those patients who assumed they were allergic without personal history of any issue. […] Penicillin allergies have been a source of anxiety for lots of people for several years. […] For these individuals, providers can consider skin testing to reassure patients that we are being appropriately cautious before giving them a test dose. […] However, when we talk to our patients about their low-risk penicillin allergies, 85% of them typically agree to just take a test dose under medical observation. […] It’s important for both our patients and the broader public good to delabel patients with inaccurate penicillin allergies. […] Penicillins are the drug of choice for many infections, are relatively narrow spectrum, are lower cost, and are often better tolerated than alternative antibiotics.

• #33 Management of Penicillin Allergy in the Perioperative Setting

  https://www.mdpi.com/2079-6382/13/2/157

  Several recent publications in orthopedic surgery describe the effectiveness of allergy referral programs for penicillin skin testing to optimize perioperative antibiotic prophylaxis. […] In these cohorts, 97–99% of patients had their penicillin allergy de-labeled, with an associated decreased risk of subsequent prosthetic joint infection compared to those who still received a second-line antibiotic. […] Other institutions and health systems have employed different clinical decision support tools to optimize cefazolin administration for surgical prophylaxis. […] The increased rates of cefazolin administration in all the above studies were not accompanied by a corresponding increase in the rate of allergic reactions, but did lead to improvements in patient outcomes. […] In view of the significant risks associated with administration of second-line antibiotics for perioperative prophylaxis, efforts are ongoing to optimize the use of cefazolin in surgical patients with PALs. […] Cefazolin use is safe in most PAL scenarios and is now recommended for routine administration without preemptive testing for penicillin tolerance in updated drug allergy practice parameters.

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