Allergy Assessment Research Articles

Penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and antimicrobial resistance (ALABAMA): protocol for a multicentre, parallel-arm, open-label, randomised pragmatic trial

IntroductionIncorrect penicillin allergy records are recognised as an important barrier to the safe treatment of infection and affect an estimated 2.7 million people in England. Penicillin allergy records are associated...

Drug allergy in older adults: A study from the United States Drug Allergy Registry

BackgroundOlder adults have an increased risk of adverse drug reactions and negative effects associated with alternative antibiotic use. Although the number of antibiotic allergies reported increases with age, the characteristics and outcomes of older adults receiving drug allergy assessment are unknown. ObjectiveTo assess the characteristics and outcomes of drug allergy evaluations in older adults. MethodsWe considered patients aged above or equal to 65 years enrolled in the United States Drug Allergy Registry (USDAR), a US multisite prospective cohort (January 16, 2019 to February 28, 2022). Data were summarized using descriptive statistics. ResultsOf 1678 USDAR participants from 5 sites, 406 older adults aged above or equal to 65 years (37% 65-69 years, 37% 70-74 years, 16% 75-79 years, and 10% ≥80 years) received 501 drug allergy assessments. USDAR older adults were primarily of female sex (69%), White (94%), and non-Hispanic (98%). Most USDAR older adults reported less than or equal to 1 infections per year (64%) and rated their general health as good, very good, or excellent (80%). Of 296 (59%) penicillin allergy assessments in USDAR older adults, 286 (97%) were disproved. Other drug allergy assessments included sulfonamide (n = 41, 88% disproved) and cephalosporin (n = 20, 95% disproved) antibiotics. All 41 drug allergy labels in USDAR participants aged above or equal to 80 years and all 80 penicillin allergy labels in USDAR men aged above or equal to 65 years were disproved. ConclusionOlder adults represented a quarter of USDAR participants but were neither racially nor ethnically diverse and were generally healthy without considerable antibiotic need. Most older adults presented for antibiotic allergy assessments, the vast majority of which were disproved. Drug allergy assessments may be underutilized in the older adults who are most vulnerable to the harms of unconfirmed antibiotic allergy labels.

Smoke exposure and childhood atopic eczema and food allergy: A systematic review and meta-analysis.

There is no consensus on the effect of timing and type of smoke exposure on early allergy development. This study aimed to determine the relationship between early eczema or food allergy/hypersensitivity development in children by firstly investigating the effect of smoke exposure across critical development periods and secondly by analyzing effects of parental atcive or passive smoking. Four databases (PubMed, Web of Science, Scopus and Embase) were searched in May 2022 and assessed by two independent reviewers. Case-control, cross-sectional or cohort studies reporting on smoke exposure from preconception to postnatal periods and atopic eczema, food allergy and/or hypersensitivity outcomes by age 3 years were included. The Newcastle-Ottawa Scale was used to assess study quality. Random effects model was used to estimate the pooled risk ratios. From 1689 identified records, 32 studies with nearly 190,000 subjects were included. Parental smoking during preconception, pregnancy and postnatal periods was generally not associated with the risk of eczema, food allergy and food sensitisation development by age 3 years. Maternal active smoking during pregnancy was negatively associated with self-reported doctor diagnosis of eczema (RR = 0.87, 95% CI 0.77-0.98; I2 = 50.56) and maternal passive smoking during pregnancy was positively associated with clinician assessment of eczema in one study (RR = 1.38; 95% CI 1.06-1.79). Our findings highlighted the importance of in utero programming in early-life allergy development. Despite the weak evidence, our results suggest pregnant women should minimise their contact with second-hand smoke to prevent offspring eczema development. There is a need for greater utilisation of objective allergy assessments in future studies.

Oral challenge vs routine care to assess low-risk penicillin allergy in critically ill hospital patients (ORACLE): a pilot randomised controlled trial

BackgroundSelf-reported penicillin allergies are highly prevalent in hospitalised patients and are associated with poor health and health service outcomes. Critically ill patients have historically been underrepresented in prospective delabelling studies in part due to concerns around clinical stability and reliability of penicillin skin testing. Allergy assessment tools exist to identify low-risk penicillin allergy phenotypes and facilitate direct oral challenge delabelling. PEN-FAST is a clinical decision rule that has been validated to predict true penicillin allergy in a cohort of non-critically ill patients. There is however limited evidence regarding the feasibility, safety and efficacy of direct oral challenges and the use of delabelling clinical decisions rules in the intensive care setting.MethodsCritically ill patients in the intensive care unit (ICU) with low-risk penicillin allergy phenotypes (PEN-FAST score < 3) will be randomised 1:1 to direct oral penicillin challenge (single dose 250 mg oral amoxicillin or implicated penicillin) or routine care, followed by a 2-h observation period. Patients will receive a second oral challenge/observation prior to hospital discharge (with subsequent observation for 2 h). An assessment for antibiotic-associated adverse events will also be undertaken at 24 h and 5 days post each challenge/observation and again at 90 days post-randomisation. The primary outcome measures are feasibility (proportion of eligible patients recruited and protocol compliance) and safety (proportion of patients who experience an antibiotic-associated immune-mediated adverse event or serious adverse event).DiscussionWe will report the feasibility and safety of point-of-care penicillin direct oral challenge in this first randomised controlled trial of low-risk penicillin allergy in critically ill hospitalised patients. Upon completion of the project, important findings will inform the design of planned large prospective multi-centre clinical trials in Australian and international ICUs, further examining safety and efficacy and exploring antimicrobial prescribing-related outcomes following penicillin oral challenge.Trial registrationAustralian New Zealand Clinical Trials RegistryRegistration Number: ACTRN12621000051842Date registered: 20/01/2021https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379735&isReview=true

Expanding the scope of the infectious diseases pharmacist in HCT: Beyond antimicrobial stewardship.

Infectious disease (ID) pharmacists and antimicrobial stewardship (AMS) programs are integral to the infection management of hematopoietic cell transplant (HCT) recipients demonstrating effective implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN), allergy assessments, and use of rapid diagnostic testing. The HCT procedure is complex, dynamic, and a high risk for infectious complications. Therefore, there is an important role for an ID and AMS pharmacist to collaborate with the primary treating team, with ongoing care, involving the optimal individual patient prophylactic, pre-emptive and treatment management of infections in this high-risk population. This review highlights key factors for consideration of ID/AMS Pharmacists in relation to HCT, including important aspects in the evaluation of infection risk prior to transplant, risk from donor sources, length of, and changes in immunosuppression, and potential drug-drug interactions from other essential supportive care therapies.

Description and accuracy of antibiotic allergy labels at North Shore Hospital.

Antibiotic allergy labels are common and associated with adverse care. Most people with an antibiotic allergy label are found to be non-allergic on investigation. The aims of this study were to evaluate the burden and accuracy of antibiotic allergy labels at North Shore Hospital and to identify and assess beta-lactam specific allergies, and the potential impact of an inpatient antibiotic allergy service. An evaluation of documented inpatient adverse drug reaction (ADR) labels. Structured assessment of beta-lactam allergies was undertaken using the Austin Health tool. Three hundred and seven patients were reviewed; 78 patients had an antibiotic allergy label, with 102 individual labels. Fifty-five of these 78 patients underwent structured assessment. Forty-four patients had a beta-lactam-specific antibiotic allergy label. Using the Austin Health tool, 9/44 (20%) of beta-lactam-specific allergy labels could have been removed following a history alone and a further 16/44 (36%) would have been appropriate for direct oral challenge. Antibiotic allergy label accuracy was 64% for beta-lactam antibiotics, and 69% for non-beta-lactams. The prevalence of antibiotic specific allergies in our centre was similar to New Zealand and Australian statistics.1,2 Our study showed that a significant proportion of inpatients with a beta-lactam-specific allergy could be de-labelled on history or with a single dose challenge.

PERIOPERATIVE ANAPHYLAXIS: A SYSTEMATIC REVIEW

Background: Perioperative anaphylaxis can be associated with antibiotics, neuromuscular blocking agents, dyes, latex, and disinfectants. This article evaluates the condition's epidemiology, pathophysiology, and treatment, including an allergy assessment.&#x0D; &#x0D; Aim: This investigation aims to investigate the possibility that perioperative anaphylaxis develops.&#x0D; &#x0D; Methods: The study met the PRISMA 2020 guidelines through self-evaluation. The investigators ensured the study's current became feasible. Publications from 2015 to 2023 were searched using various online reference databases, including Pubmed and SagePub. Excluded were review papers, pre-existing publications, and incomplete articles.&#x0D; &#x0D; Result: The search generated 552 and 321 articles in the PubMed and SagePub databases, respectively. 54 articles were found for PubMed and 21 for SagePub in the investigation conducted for the last year of 2015. A total of 18 papers were collected, with 12 generated from PubMed and 6 from SagePub. We included five studies that met the criteria.&#x0D; &#x0D; Conclusion: The presence of anesthetics, surgical settings, and various medications and substances may complicate the process of accurate diagnosis. A systematic approach was used to identify the reaction, perpetrator, and future management. Effective management of perioperative anaphylaxis requires close coordination among anesthesiology, surgery, and allergy specialists.

Efficacy of a Pharmacy Resident-Driven Beta-Lactam Allergy Assessment at a Community Hospital

Abstract Background Beta-lactams are the most commonly used antibiotics, although they are also associated with hypersensitivity reactions. Although approximately 10% of the population report an allergy to a beta-lactam, identifying erroneous beta-lactam allergies can lead to improved patient outcomes and lower rates of antimicrobial resistance. Methods This study was a single-center, retrospective review of a pharmacy resident driven beta-lactam allergy assessment. The allergy assessment consisted of a chart review and a 3-question interview. The primary outcome of this study was a composite of the following interventions: beta-lactam allergy delabeling, reaction specification, and/or identification of previously tolerated beta-lactams. Secondary outcomes included patients who were relabeled if delabeling occurred, patients who received beta-lactam therapy after changes occurred to their charted allergy, and impact on hospital utilization of beta-lactam alternative antibiotics. Results A total of 42 patients were interviewed between September 13, 2021, and December 17, 2021, with follow-up occurring 90 days after the initial interview. The most common beta-lactam allergy reported was penicillin (90.5%). Of the patients who were assessed, 95.2% met at least one of the components of the primary endpoint. Specifying the previous toleration of beta-lactam agents was the most common intervention, occurring after 78.6% of assessments. Complete delabeling of the patient's beta-lactam allergy occurred after 38.1% of the interviews conducted. Conclusions A pharmacy-resident driven beta-lactam allergy assessment was effective at clarifying beta-lactam allergies, including the complete delabeling of erroneous beta-lactam allergies.

Food anaphylaxis diagnostic marker compilation in machine learning design and validation.

Traditional food allergy assessment of anaphylaxis remains limited in accuracy and accessibility. Current methods of anaphylaxis risk assessment are costly with low predictive accuracy. The Tolerance Induction Program (TIP) for anaphylactic patients undergoing TIP immunotherapy produced large-scale diagnostic data across biosimilar proteins, which was used to develop a machine learning model for patient-specific and allergen-specific anaphylaxis assessment. In explanation of construct, this work describes the algorithm design for assignment of peanut allergen score as a quantitative measure of anaphylaxis risk. Secondarily, it confirms the accuracy of the machine learning model for a specific cohort of food anaphylactic children. Machine learning model design for allergen score prediction utilized 241 individual allergy assays per patient. Accumulation of data across total IgE subdivision served as the basis of data organization. Two regression based Generalized Linear Models (GLM) were utilized to position allergy assessment on a linear scale. The initial model was further tested with sequential patient data over time. A Bayesian method was then used to improve outcomes by calculating the adaptive weights for the results of the two GLMs of peanut allergy score prediction. A linear combination of both provided the final hybrid machine learning prediction algorithm. Specific analysis of peanut anaphylaxis within one endotype model is estimated to predict the severity of possible anaphylactic reaction to peanut with a recall of 95.2% on a dataset of 530 juvenile patients with various food allergies, including but not limited to peanut allergy. Receiver Operating Characteristic analysis yielded over 99% AUC (area under curve) results within peanut allergy prediction. Machine learning algorithm design established from comprehensive molecular allergy data produces high accuracy and recall in anaphylaxis risk assessment. Subsequent design of additional food protein anaphylaxis algorithms is needed to improve the precision and efficiency of clinical food allergy assessment and immunotherapy treatment.

Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience.

Oral food challenges (OFC) are an important tool in the assessment of food allergy. We sought to identify factors available at initial assessment visit which were associated with successful outcome or challenge failure in Australian children. We conducted a retrospective review of all paediatric patients who underwent OFC in our allergy service over a 5-year period. Clinical data comprising patient demographics, co-morbidities, skin prick test (SPT) results, nature of previous reactions, elapsed time since previous reactions and outcome at OFC were recorded. Four hundred and fifty-six OFCs were conducted, with 56 cases (12.3%) resulting in a reaction. Likelihood of reaction at OFC was significantly increased for patients with atopic dermatitis (odds ratio 1.99). When stratified by food substance, atopic dermatitis had the strongest association with reaction within the peanut group (odds ratio 3.2), and no association was demonstrated for soy or prawn. Increasing SPT wheal size (P < 0.001) and previous history of anaphylaxis to the challenge food (P < 0.001) correlated with failure at OFC. A low-risk group was identified, of patients with no clear history of prior reaction to the challenge food, and SPT result <3 mm. Factors identified at assessment visit which correlated with reaction at OFC are atopic dermatitis, prior history of anaphylaxis, and increasing SPT wheal size. Domiciliary OFC could be considered in a select low-risk group of patients undergoing food challenge. This study was performed at a single centre with limited sample size, further large-scale and multicentre study verification of our data will provide more accurate representation of the Australian demographic.

CATALYST: challenging antibiotic allergy status.

To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital. A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention. CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot. CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.

A Meta-Analysis of the Prevalence of Wheat Allergy Worldwide.

Wheat allergy is a primary disease of food allergy, and its global prevalence is unclear. This study aimed to characterize the latest worldwide prevalence of wheat allergy based on five different diagnostic methods. Study searches were conducted in Web of Science, PubMed, Ovid LWW, and Cochrane database, with a time limit of 1 January 2007 to 1 September 2022. The review and screening of the articles was undertaken by two independent reviewers. The statistical analysis was conducted by R. A total of 56 articles were finally included. The prevalence of wheat allergy was 0.63% (95% CI: 0.43-0.87%) for self-reported, 0.70% (95% CI: 0.18-1.22%) for self-reported physician-diagnosed, 0.22% (95%CI: 0.07-0.65%) for skin prick test positive, 0.97% (95% CI: 0.43-2.20%) for specific immunoglobulin E positive, and 0.04% (95% CI: 0-0.16%) for food challenge. However, food challenge can be largely subjective, and the results were only based two countries, so the prevalence of wheat allergy confirmed by food challenge may be not entirely trustworthy. In conclusion, investigating the prevalence of wheat allergy in the real world as accurately as possible will contribute to the prevention, management, and risk assessment of wheat allergy.

Meropenem allergy testing performed at the bedside of hospitalized patients labelled with a penicillin allergy

BackgroundMeropenem is a widely prescribed beta-lactam for hospitalized patients. There are few data on meropenem allergy assessments in inpatients with a reported history of penicillin allergy who require a treatment with meropenem. This can lead to the use of less effective second-line antibiotics that may increase antibiotic resistances. We aimed to evaluate the clinical outcomes of a meropenem allergy assessment in admitted patients with a reported history of penicillin allergy that required meropenem for the treatment of an acute infection. MethodsA retrospective analysis was performed on 182 inpatients labelled with a penicillin-allergy who received meropenem after an allergy assessment. The allergy study was performed bedside if meropenem was required urgently. The study included skin prick tests (SPTs) followed by an intradermal skin test (IDT) to meropenem, and a meropenem drug challenge test (DCT). If a non-immediate reaction to a beta-lactam was suspected, it was initiated with patch tests. ResultsThe median age of the patients was 59.7 years (range 28–95) and 80 (44%) were women. A total of 196 sets of diagnostic workups were performed, with 189 (96.4%) of them being tolerated. Only two patients had a positive meropenem IV DCT, both presenting a non-severe cutaneous reaction that completely resolved after treatment. ConclusionsThis study evidenced that a bedside meropenem allergy assessment of hospitalized patients labelled with a ‘penicillin allergy’ who require a broad-spectrum antibiotic for empiric coverage is a safe and effective procedure, avoiding the use of second-line antimicrobial agents.

Qualitative analysis of telephonic comprehensive medication review content and delivery.

Comprehensive medication reviews (CMRs) are offered to eligible Medicare beneficiaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear. To qualitatively assess CMR content and delivery among telephonic CMR providers. This qualitative thematic analysis used transcriptions of audio-recorded patient interactions during CMRs from 3 telephonic medication therapy management provider organizations. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha. Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/cost; identity/privacy/recording; and patient's medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assessment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: documentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered. These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among organizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining flexibility for pharmacists to provide patient-oriented CMRs that meet patients' clinical needs.

Study protocol for PREPARE: a phase II feasibility/safety randomised controlled trial on PeRiopErative Penicillin AlleRgy TEsting

IntroductionPatient-reported antibiotic allergy labels (AALs) are common. These labels have been demonstrated to have a negative impact on use of appropriate antibiotics and patient-related health outcomes. These patients are more...

Low frequency of allergy referral for penicillin allergy evaluation in an urban Boston primary care setting.

A key strategy to combat the public health crisis of antimicrobial resistance is to use appropriate antibiotics, which is difficult in patients with a penicillin allergy label. Our aim was to investigate racial and ethnic differences related to penicillin allergy labeling and referral to allergy/immunology in primary care. This was a retrospective study of Tufts Medical Center's Boston-based primary care patients in 2019. Univariable and multivariable logistic regression models were used to examine demographic associations with (1) penicillin allergy label and (2) allergist referral. Of 21,918 primary care patients, 2,391 (11%) had a penicillin allergy label; of these, 249 (10%) had an allergist referral. In multivariable logistic regression models, older age (adjusted odds ratio [aOR]= 1.06 [95% CI= 1.04-1.09]) and female sex (aOR= 1.58 [95% CI = 1.44-1.74]) were associated with higher odds of penicillin allergy label carriage. Black race (aOR= 0.77 [95% CI= 0.69-0.87]) and Asian race (aOR= 0.47 [95%CI = 0.41-0.53]) were associated with lower odds of penicillin allergy label carriage. In multivariable regression, allergist referral was associated with female sex (aOR= 1.52 [95% CI= 1.10-2.10]) and Black race (aOR= 1.74 [95% CI= 1.25-2.45]). Of 93 patients (37%) who completed their allergy visit, 26 (28%) had received penicillin allergy evaluation or were scheduled to receive a penicillin allergy evaluation at a future visit. There were racial differences in penicillin allergy labeling and referral. Allergy referral for penicillin allergy assessment was rare. Larger studies are needed to assess penicillin allergy labeling and delabeling with an equity focus on optimizing patient health outcomes.

Drug Allergy Assessments in Older Adults: A Multi-Site Prospective Study from the United States Drug Allergy Registry

Older adults have an increased risk of adverse drug reactions and are more likely to suffer adverse effects associated with alternative antibiotic use. Although antibiotic allergy reporting increases with age and medical complexity, the epidemiology and outcomes of older adults receiving drug allergy assessment are unknown.

Sensibilisation allergénique et asthme sévère en France : résultats de l’étude FASE-CPHG

IntroductionSevere asthma is a disease with many phenotypes. In this new subanalysis of the results of the FASE-CPHG study, one objective was to describe the allergenic sensitization profile of patients with severe asthma and to compare this profile with phenotyping in the same population. MethodsThe FASE-CPHG study is an observational, descriptive, and multicenter study investigating a population of patients with severe asthma cared for in 70 general hospitals in France between March 2016 and July 2017. ResultsOf the 1,502 patients included, 1,465 could be analyzed and their data were used for this study. An allergy assessment was undertaken: a skin test in 71% of the patients, and specific IgE assays in 37% of the patients. When the skin tests were done, 71.2% were positive for at least one allergen (sensitization to dust mites, 79%; grasses, 48%; cats, 40%; Betulaceae, 15.5%; cockroaches, 7.1%; Alternaria, 10.9%). A blood eosinophilia count was performed in 75% of the patients (count > 300/mm3 in 53% of the cases). Five severe asthma phenotypes were identified: early allergic asthma (sensitization to at least one allergen in 87% of the cases), obesity and asthma (sensitization in 64%), late-onset obstructive asthma (sensitization in 14%), late-onset eosinophilic asthma (sensitization in 43%), asthma and intolerance to aspirin (sensitization in 66%). ConclusionThis study demonstrated that in daily practice the allergy assessment was only carried out in 80% of patients who had severe asthma. An allergy assessment seems desirable for any phenotype of severe asthma; the prevalence of allergenic sensitization is also important within late-onset asthma phenotypes that are reputed to be non-allergic.

Prospective Assessment of Penicillin Allergy (PAPA): Evaluating the performance of penicillin allergy testing and post-delabelling outcomes among Hong Kong Chinese.

Incorrect penicillin 'allergy' labels predispose patients to adverse outcomes but are under-recognised in many Asian countries. Studies on performance and post-delabelling outcomes of penicillin allergy evaluation among Chinese remain scarce. To evaluate the diagnostic performance of allergy testing and post-delabelling outcomes among Chinese patients in a prospective penicillin allergy cohort - Prospective Assessment of Penicillin Allergy (PAPA). All adult patients (age ≥ 18 years) who underwent penicillin allergy evaluation between January 2020 to December 2021 were recruited and prospectively reviewed by both medical records and individual interviews at least 6 months after delabelling or allergy confirmation. Out of 372 patients who completed penicillin allergy evaluation, 335 (90%) patients were delabelled. The overall negative predictive value of penicillin skin testing was 95%, but lower for patients with non-immediate type reactions (88%). History of non-immediate symptom onset (OR = 4.501 [95%CI = 2.085-9.716], p < 0.001) and duration since index reaction (OR = 0.942 [95%CI = 0.899-0.987], p = 0.012) were associated with positive skin testing. After at least 6 months, 60 (18%) of de-labelled patients had received penicillins again without any adverse reactions. Fluoroquinolone-use was significantly lower among delabelled patients compared to those with penicillin allergy (38[11%] vs 11[30%], p = 0.004). After at least 6 months, one in six delabelled patients already received penicillins again safely, with significantly lower fluoroquinolone usage. None experienced adverse reactions. History of non-immediate onset and shorter duration since index reaction were associated with genuine allergy. In patients with severe non-immediate reactions, skin tests should be supplemented with thorough clinical history and adjunct diagnostic evaluations.

ANTIMICROBIAL ALLERGY ASSESSMENT DURING PREGNANCY FOR APPROPRIATE ANTIMICROBIAL USE AT DELIVERY

Avoidance of suspect drugs based solely on a history of drug allergy is detrimental to disease outcomes. Many antimicrobial allergy labels are not usually true allergy. Some studies have demonstrated that antimicrobial allergy assessments can be safely performed on pregnant women. The purpose of this study was to examine the usefulness of antibiotic allergy assessment during pregnancy in Japan. We reviewed pregnant women who reported antimicrobial allergies and were referred to the allergy center. Allergists conducted an interview and skin test and selected antibiotics that could be used at delivery. Twenty-four pregnant women were referred to as having antimicrobial allergies. Most of the suspected antimicrobials were cephalosporin (13 cases, 52%) and penicillin (9 cases, 36%). Five women were ruled out only by our interviews. Of the remaining 20 cases, 10 were immediate type, 6 were non-immediate type, and 4 were unknown. All 21 pregnant women who needed antimicrobials were able to use the first-line drugs (β-lactam antimicrobials) at the time of delivery. No surgical site infections or allergic reactions were observed. Pregnant women with antimicrobial allergy labels could be evaluated by antimicrobial allergy assessment during pregnancy, and first-line antimicrobials were safely and properly used at delivery.