Use of a beta-lactam graded challenge process for inpatients with self-reported penicillin allergies at an academic medical center

Frontiers in Allergy

Allergy

Erica J. Stohs¹  Trevor C. Van Schooneveld¹  Sara M. May¹  Bryan T. Alexander²  Molly M. Miller²  Danny Schroeder²  Shawnalyn W. Sunagawa²  Emily Kreikemeier²  Scott J. Bergman³  Andrew B. Watkins⁴ 

[1] Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States;Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States;Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, United States;Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States;Department of Pharmacy, St. Dominic Jackson Memorial Hospital, Jackson, MS, United States;

关键词: penicillin allergy;    graded challenge;    graded challenge (test dose);    penicillin allergy delabelling;    penicillin allergy screening algorithm;   

DOI  :  10.3389/falgy.2023.1161683

 received in 2023-02-08, accepted in 2023-06-29,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe Antimicrobial Stewardship Program (ASP) at Nebraska Medicine collaborated with a board-certified allergist to develop a penicillin allergy guidance document for treating inpatients with self-reported allergy. This guidance contains an algorithm for evaluating and safely challenging penicillin-allergic patients with beta-lactams without inpatient allergy consults being available.MethodsFollowing multi-disciplinary review, an order set for beta-lactam graded challenges (GC) was implemented in 2018. This contains recommended monitoring and detailed medication orders to challenge patients with various beta-lactam agents. Inpatient orders for GC from 3/2018–6/2022 were retrospectively reviewed to evaluate ordering characteristics, outcomes of the challenge, and whether documentation of the allergy history was updated. All beta-lactam challenges administered to inpatients were included, and descriptive statistics were performed.ResultsOverall, 157 GC were administered; 13 with oral amoxicillin and 144 with intravenous (IV) beta-lactams. Ceftriaxone accounted for the most challenges (43%). All oral challenges were recommended by an Infectious Diseases consult service, as were a majority of IV challenges (60%). Less than one in five were administered in an ICU (19%). Almost all (n = 150, 96%) were tolerated without any adverse event. There was one reaction (1%) of hives and six (4%) involving a rash, none of which had persistent effects. Allergy information was updated in the electronic health record after 92% of the challenges.ConclusionBoth intravenous and oral beta-lactam graded challenges were implemented successfully in a hospital without a regular inpatient allergy consult service. They were well-tolerated, administered primarily in non-ICU settings, and were often ordered by non-specialist services. In patients with a self-reported penicillin allergy, these results demonstrate the utility and safety of a broadly adopted beta-lactam GC process.

【 授权许可】

Unknown   
© 2023 Sunagawa, Bergman, Kreikemeier, Watkins, Alexander, Miller, Schroeder, Stohs, Van Schooneveld and May.