Abstract
Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.
| Original language | English |
|---|---|
| Pages (from-to) | e82-e94 |
| Number of pages | 13 |
| Journal | British Journal of Anaesthesia |
| Volume | 123 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jul 2019 |
Keywords
- allergy
- drug provocation testing
- penicillin
- prophylaxis
- surgery
- surgical site infection
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In: British Journal of Anaesthesia, Vol. 123, No. 1, 01.07.2019, p. e82-e94.
Research output: Contribution to journal › Review Article › Research › peer-review
TY - JOUR
T1 - Management of a surgical patient with a label of penicillin allergy
T2 - narrative review and consensus recommendations
AU - Savic, L. C.
AU - Khan, D. A.
AU - Kopac, P.
AU - Clarke, R. C.
AU - Cooke, P. J.
AU - Dewachter, P.
AU - Ebo, D. G.
AU - Garcez, T.
AU - Garvey, L. H.
AU - Guttormsen, A. B.
AU - Hopkins, P. M.
AU - Hepner, D. L.
AU - Kolawole, H.
AU - Krøigaard, M.
AU - Laguna, J. J.
AU - Marshall, S. D.
AU - Mertes, P. M.
AU - Platt, P. R.
AU - Rose, M. A.
AU - Sabato, V.
AU - Sadleir, P. H.M.
AU - Savic, S.
AU - Takazawa, T.
AU - Voltolini, S.
AU - Volcheck, G. W.
N1 - Funding Information: PD has received lecture and travel fees from MSD France (Courbevoie, France), lecture and travel fees from Bracco Imaging France (Courcouronnes, France), and from Agence Nationale de S?curit? du M?dicament et des Produits de Sant? (Saint-Denis, France). He was an expert for a task force group dedicated to ?neuromuscular blocking agents and anaphylactic reactions? (until 2016) and is an MSD Expert Board on ?neuromuscular blocking agents and fast-tracking anesthesia? (until October 2019). LHG is a consultant and adjudication committee member for Merck (Kenilworth, NJ, USA) and Novo Nordisk (Gatwick, West Sussex, Denmark). PMH is an Editorial Board Member of the British Journal of Anaesthesia. PMM is a scientific advisor for the Allergy to Neuromuscular Blocking Agents and Pholcodine Exposure study (NCT02250729), funded by a consortium of pharmaceutical companies: Zambon, URGO, Pierre Fabre, Boots, Hepatoum, Biocodex, Sanofi, LBR, GSK, APL, Bell's Healthcare, Pinewood, T & R, and Ernest Jackson. PK has received lectures fees from Novartis Pharma Services Inc. and Shire Pharmaceuticals Group Plc. SDM is in receipt of an Australian National Health and Medical Research Council ECR Fellowship for the investigation of cognitive aids in emergencies. All other authors confirm that they have no interests to declare. Funding Information: PD has received lecture and travel fees from MSD France (Courbevoie, France), lecture and travel fees from Bracco Imaging France (Courcouronnes, France), and from Agence Nationale de Sécurité du Médicament et des Produits de Santé (Saint-Denis, France). He was an expert for a task force group dedicated to ‘neuromuscular blocking agents and anaphylactic reactions’ (until 2016) and is an MSD Expert Board on ‘neuromuscular blocking agents and fast-tracking anesthesia’ (until October 2019). LHG is a consultant and adjudication committee member for Merck (Kenilworth, NJ, USA) and Novo Nordisk (Gatwick, West Sussex, Denmark). PMH is an Editorial Board Member of the British Journal of Anaesthesia. PMM is a scientific advisor for the Allergy to Neuromuscular Blocking Agents and Pholcodine Exposure study (NCT02250729), funded by a consortium of pharmaceutical companies: Zambon, URGO, Pierre Fabre, Boots, Hepatoum, Biocodex, Sanofi, LBR, GSK, APL, Bell's Healthcare, Pinewood, T & R, and Ernest Jackson. PK has received lectures fees from Novartis Pharma Services Inc. and Shire Pharmaceuticals Group Plc. SDM is in receipt of an Australian National Health and Medical Research Council ECR Fellowship for the investigation of cognitive aids in emergencies. All other authors confirm that they have no interests to declare. Publisher Copyright: © 2019 British Journal of Anaesthesia Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.
AB - Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.
KW - allergy
KW - drug provocation testing
KW - penicillin
KW - prophylaxis
KW - surgery
KW - surgical site infection
UR - http://www.scopus.com/inward/record.url?scp=85062617784&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2019.01.026
DO - 10.1016/j.bja.2019.01.026
M3 - Review Article
C2 - 30916014
AN - SCOPUS:85062617784
SN - 0007-0912
VL - 123
SP - e82-e94
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -