Direct Oral Challenge is Non-inferior to Skin Testing in Low-risk Penicillin Allergy Patients

Clinical question: Is there an alternative to penicillin skin testing for low-risk penicillin allergies?    Dr. Miller Background: While approximately 10% of the population report penicillin allergies, studies indicate that more than 95% of these individuals will have negative allergy testing and can tolerate penicillin. The current gold standard for relabeling a penicillin allergy involves skin testing followed by direct oral challenge. However, specialized allergy skin testing is not universally accessible, and can be labor-intensive and costly. Moreover, skin testing alone doesn’t conclusively demonstrate penicillin tolerance. Study design: Multicenter, open-label, randomized, controlled trial     Setting: Six large academic centers in three countries   Synopsis: 382 outpatient adults labeled with a reported penicillin allergy were assessed using the PEN-FAST scoring system. Those with a PEN-FAST score of less than 3 and no history of anaphylaxis were eligible. Participants were randomized to either intradermal testing followed by direct oral challenge or direct oral challenge alone. The primary outcome showed one patient in each intervention group experienced immune-mediated reactions, both managed with a single dose of an oral antihistamine. Limitations include lower PEN-FAST scores for almost all enrollees (scores of 0-1) and an exclusion of patients with a history of anaphylaxis. In addition, most of the participants were white, limiting the study’s ...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines In the Literature Source Type: research