Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

L. C. Savic; D. A. Khan; P. Kopac; R. C. Clarke; P. J. Cooke; P. Dewachter; D. G. Ebo; T. Garcez; L. H. Garvey; A. B. Guttormsen; P. M. Hopkins; D. L. Hepner; H. Kolawole; M. Krøigaard; J. J. Laguna; S. D. Marshall; P. M. Mertes; P. R. Platt; M. A. Rose; V. Sabato; P. H.M. Sadleir; S. Savic; T. Takazawa; S. Voltolini; G. W. Volcheck

doi:10.1016/j.bja.2019.01.026

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

L. C. Savic^*, D. A. Khan, P. Kopac, R. C. Clarke, P. J. Cooke, P. Dewachter, D. G. Ebo, T. Garcez, L. H. Garvey, A. B. Guttormsen, P. M. Hopkins, D. L. Hepner, H. Kolawole, M. Krøigaard, J. J. Laguna, S. D. Marshall, P. M. Mertes, P. R. Platt, M. A. Rose, V. SabatoP. H.M. Sadleir, S. Savic, T. Takazawa, S. Voltolini, G. W. Volcheck

^*Corresponding author for this work

Department of Clinical Medicine

14 Citations (Scopus)

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
Journal	British Journal of Anaesthesia
Volume	123
Issue number	1
Pages (from-to)	e82-e94
ISSN	0007-0912
DOIs	https://doi.org/10.1016/j.bja.2019.01.026
Publication status	Published - 2019

Keywords

allergy
drug provocation testing
penicillin
prophylaxis
surgery
surgical site infection

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10.1016/j.bja.2019.01.026

http://bjanaesthesia.org/article/S0007091219300686/pdf

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Savic, L. C., Khan, D. A., Kopac, P., Clarke, R. C., Cooke, P. J., Dewachter, P., Ebo, D. G., Garcez, T., Garvey, L. H., Guttormsen, A. B., Hopkins, P. M., Hepner, D. L., Kolawole, H., Krøigaard, M., Laguna, J. J., Marshall, S. D., Mertes, P. M., Platt, P. R., Rose, M. A., ... Volcheck, G. W. (2019). Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations. British Journal of Anaesthesia, 123(1), e82-e94. https://doi.org/10.1016/j.bja.2019.01.026

Savic, LC, Khan, DA, Kopac, P, Clarke, RC, Cooke, PJ, Dewachter, P, Ebo, DG, Garcez, T, Garvey, LH, Guttormsen, AB, Hopkins, PM, Hepner, DL, Kolawole, H, Krøigaard, M, Laguna, JJ, Marshall, SD, Mertes, PM, Platt, PR, Rose, MA, Sabato, V, Sadleir, PHM, Savic, S, Takazawa, T, Voltolini, S & Volcheck, GW 2019, 'Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations', British Journal of Anaesthesia, vol. 123, no. 1, pp. e82-e94. https://doi.org/10.1016/j.bja.2019.01.026

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title = "Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations",

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.",

keywords = "allergy, drug provocation testing, penicillin, prophylaxis, surgery, surgical site infection",

author = "Savic, {L. C.} and Khan, {D. A.} and P. Kopac and Clarke, {R. C.} and Cooke, {P. J.} and P. Dewachter and Ebo, {D. G.} and T. Garcez and Garvey, {L. H.} and Guttormsen, {A. B.} and Hopkins, {P. M.} and Hepner, {D. L.} and H. Kolawole and M. Kr{\o}igaard and Laguna, {J. J.} and Marshall, {S. D.} and Mertes, {P. M.} and Platt, {P. R.} and Rose, {M. A.} and V. Sabato and Sadleir, {P. H.M.} and S. Savic and T. Takazawa and S. Voltolini and Volcheck, {G. W.}",

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language = "English",

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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.

PY - 2019

Y1 - 2019

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

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DO - 10.1016/j.bja.2019.01.026

M3 - Review

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 -

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Abstract

Keywords

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