Testing for Penicillin Allergy May Cut ‘Superbug’ Infection Risk

 

World-first testing strategy for penicillin allergy

Video taken from the channel: The University of Western Australia


 

Are you actually allergic to penicillin?

Video taken from the channel: Good Morning America


 

Evaluation & Management of Penicillin Allergy

Video taken from the channel: Mayo Proceedings


 

How Penicillin Allergy Testing is Done

Video taken from the channel: Parkland Memorial Hospital


 

Medical Mythbusters Penicillin Allergy Cross-Reactivity

Video taken from the channel: Cottage Health


 

Penicillin Allergy: Evaluation and Testing

Video taken from the channel: JAMA Network


 

Penicillin allergy could cause superbug infection

Video taken from the channel: ANI News Official


WEDNESDAY, June 27, 2018 (HealthDay News) People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. “We know that more than 95 percent of patients with an indication of a penicillin allergy. Testing for Penicillin Allergy May Cut ‘Superbug’ Infection Risk. WEDNESDAY, June 27, 2018 People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests.

But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. WEDNESDAY, June 27, 2018 (HealthDay News) People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. “We know that more than 95 percent of patients with an indication of a penicillin allergy. WEDNESDAY, June 27, 2018 (HealthDay News) People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests.

But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. WEDNESDAY, June 27, 2018 — People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. “We know that more than 95 percent of patients with an indication of a penicillin allergy in their medical record. Testing for Penicillin Allergy May Cut ‘Superbug’ Infection Risk.

Jun 27 2018. HealthDay News. WEDNESDAY, June 27, 2018 (HealthDay News) — People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. But testing folks to make sure they really are allergic to penicillin could.

WEDNESDAY, June 27, 2018 (HealthDay News) — People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. But testing folks to make sure they really are allergic to penicillin could lower that danger, the researchers added. “We know that more. Testing for Penicillin Allergy May Cut ‘Superbug’ Infection Risk. WEDNESDAY, June 27, 2018 (HealthDay News) — People believed to have a penicillin allergy are often prescribed much stronger antibiotics that can raise their risk for dangerous infections, a new study suggests. A positive result means the patient is likely to have a penicillin allergy.

If negative, the skin test is usually followed by an oral penicillin class challenge (e.g., with amoxicillin) to safely rule out an IgE-mediated penicillin allergy.1,7 The current standard of care is to perform a skin test with the major determinant penicilloylpolylysine and commercially-available penicillin G. BACKGROUND: Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics.

We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin.

List of related literature:

Since about 10% of patients who report a penicillin allergy are truly allergic, omitting MDM from skin testing may fail to detect about 1–2% (10–20% of 10%) of ‘all comers’ who are labeled penicillin allergic.

“Pediatric Allergy: Principles and Practice E-Book” by Donald Y. M. Leung, Hugh Sampson, Raif Geha, Stanley J. Szefler
from Pediatric Allergy: Principles and Practice E-Book
by Donald Y. M. Leung, Hugh Sampson, et. al.
Elsevier Health Sciences, 2010

Performing skin testing and challenges to penicillin can prevent serious adverse complications resulting from unverified penicillin allergies including hospital-acquired infections and antibiotic resistance, as well as reduce health care utilization required for drug desensitizations.

“Medical Secrets E-Book” by Mary P. Harward
from Medical Secrets E-Book
by Mary P. Harward
Elsevier Health Sciences, 2018

Because variable IgE antibody levels to penicillin are common, skin testing for penicillin allergy becomes problematic.

“Pharmacology and Therapeutics for Dentistry E-Book” by Frank J. Dowd, John A. Yagiela, Bart Johnson, Angelo Mariotti, Enid A. Neidle
from Pharmacology and Therapeutics for Dentistry E-Book
by Frank J. Dowd, John A. Yagiela, et. al.
Elsevier Health Sciences, 2010

If the rash to ampicillin or amoxicillin is urticarial or systemic or the history is unclear, the patient should undergo penicillin skin testing if a penicillin is needed.

“Nelson Textbook of Pediatrics E-Book” by Robert M. Kliegman, Bonita F. Stanton, Joseph St. Geme, Nina F Schor, Richard E. Behrman
from Nelson Textbook of Pediatrics E-Book
by Robert M. Kliegman, Bonita F. Stanton, et. al.
Elsevier Health Sciences, 2011

It has been reported that 80% to 90% of those patients with self-reported penicillin allergy have no evidence of IgE antibodies to penicillin on skin testing (Park & Li, 2005).

“Brunner & Suddarth's Textbook of Canadian Medical-surgical Nursing” by Rene A. Day, Pauline Paul, Beverly Williams
from Brunner & Suddarth’s Textbook of Canadian Medical-surgical Nursing
by Rene A. Day, Pauline Paul, Beverly Williams
Lippincott Williams & Wilkins, 2009

When the history of allergy is not clear cut and it is necessary to prescribe a penicillin, the presence of IgE antibodies in serum is a useful indicator of reactions mediated by these antibodies, i.e. immediate (type I) reactions.

“Clinical Pharmacology” by Morris J. Brown, Pankaj Sharma, Peter N. Bennett
from Clinical Pharmacology
by Morris J. Brown, Pankaj Sharma, Peter N. Bennett
Elsevier Health Sciences, 2012

Assuming rigorous testing, infections with penicillin-susceptible, β-lactamase-negative organisms can be treated with penicillin.

“Principles and Practice of Pediatric Infectious Diseases E-Book” by Sarah S. Long, Larry K. Pickering, Charles G. Prober
from Principles and Practice of Pediatric Infectious Diseases E-Book
by Sarah S. Long, Larry K. Pickering, Charles G. Prober
Elsevier Health Sciences, 2012

Penicillin skin tests can be helpful in determining whether it is safe to administer penicillin to a patient with suspected penicillin allergy.

“Mayo Clinic Internal Medicine Board Review” by Amit K. Ghosh
from Mayo Clinic Internal Medicine Board Review
by Amit K. Ghosh
OUP USA, 2010

Penicillin is a frequent cause of anaphylaxis and is still the only antibiotic with reliable predictive values on skin testing for IgE-mediated reactions.

“Comprehensive Pediatric Hospital Medicine E-Book” by Lisa B. Zaoutis, Vincent W. Chiang
from Comprehensive Pediatric Hospital Medicine E-Book
by Lisa B. Zaoutis, Vincent W. Chiang
Elsevier Health Sciences, 2007

More than 80% of patients with a self reported allergy to penicillin have no evidence of IgE antibodies on skin testing.

“Clinical Pharmacy and Therapeutics E-Book” by Roger Walker, Cate Whittlesea
from Clinical Pharmacy and Therapeutics E-Book
by Roger Walker, Cate Whittlesea
Elsevier Health Sciences, 2011

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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  • 0:00 Introduction

    1:22 Risk Stratification

    3:08 Preparation for All Patients Before Penicillin Allergy Testing

    4:38 Anaphylaxis Kit in Your Clinical Area

    5:19 Testing Low-Risk Patients

    7:20 Management of Anaphylaxis

    8:16 Testing Moderate-Risk Patients: Step 1 Skin Prick Test

    11:46 Testing Moderate-Risk Patients: Step 2 Intradermal Test

    13:05 Testing Moderate-Risk Patients: Step 3 Oral Amoxicillin Challenge

    13:59 Updating EMR

    16:30 Additional Considerations