Questionnaire identifies patients at low risk for penicillin allergy
Click Here to Manage Email Alerts
Key takeaways:
- A questionnaire successfully identified patients with STIs at low risk for penicillin allergy.
- Among low-risk patients, skin test and two-step graded oral challenge were both effective test methods.
Researchers found that a questionnaire successfully identified patients with STIs who can be safely evaluated for penicillin allergy by skin test or by a two-step graded oral challenge, according to a study.
“Providers caring for clients with STIs are often faced with clients reporting a history of penicillin allergy (up to 15% of clients). Penicillin remains the drug of choice for the treatment of all stages of syphilis,” Rebecca A. Lillis, MD, associate professor at the Louisiana State University School of Medicine, told Healio.
“Ceftriaxone is the drug of choice for treatment of gonorrhea and often avoided in clients who report a penicillin allergy, resulting in suboptimal care,” she said.
Lillis and colleagues conducted a randomized controlled trial to evaluate a questionnaire used as a penicillin allergy evaluation.
According to the study, participants with reported penicillin allergies responded to a questionnaire to stratify risk. From there, low-risk participants underwent penicillin skin testing (PST), followed by amoxicillin challenge or a graded oral challenge (GOC) —25 mg of amoxicillin, followed by an additional 250 mg of amoxicillin.
A total of 284 participants were initially included in the study, although 72 were considered “high risk” and were excluded.
Of the 206 participants considered “low risk,” 102 (49.5%) underwent PST without reactions, although three (3%) had mild reactions during the oral challenge. Of the 104 (50.5%) participants in the GOC, 95 (91.3%) completed challenges without reaction, although four (4.2%) had mild symptoms after 25 mg of amoxicillin and four (4.2%) had mild symptoms after receiving 250 mg of amoxicillin.
Participating providers were also surveyed at the start and end of the study about the feasibility of the penicillin allergy evaluation. Of the 12 that completed the survey, 11 (93%) said that the assessment questionnaire was safe and effective in STI clinics. They noted, however, that barriers to implementation of the questionnaire included providers included cost of reagents, reimbursement and time constraints.
“In STI clinic settings with low-risk patients, using a two-step graded oral challenge is a feasible, acceptable, and effective way to de-label patients reporting penicillin allergy and provide a pathway to improving patient care and antibiotic stewardship,” Lillis concluded.
Collapse
Read more about
Click Here to Manage Email Alerts