PCN Allergy PRESENTATION

delabeling

Penicillin allergy

start

By: Vasiliki Gliagias

Long ago, penicillin was discovered and greatly reduced number of deaths from infection. As expansion of penicillin arose so did reports of anaphylaxis and the advent of false allergy. Our only hope is becoming masters of recognizing false penicillin allergy so that we may delabel patients when appropriate.

Approximately 10% of the general population report apenicillin allergy, but only <1% are truly allergic.

<1%

Truly PCN allergic

More than 20 million persons in North America likely to be harboring a penicillin allergy label

Breaking down risk

NO or LOW

Consider delabeling on the spot or referring for drug challenge

MEDIUM

Refer for skin test

HIGH

Refer for skin test or desensitization if clinically impacting

no risk

Chills/Fatigue, Headache

Isolated GI upset (stomach ache, N/V, diarrhea)

delabel

Family Hx of PCN Allergy/ denies allergy but on record

Hx of Amoxicillin Use w/o reaction

Drug allergy: A 2022 practice parameter update

Low risk

Pruritus w/o rash

Delayed-onset rash (i.e. >4 hours)

Direct amoxicillin challenge

Unknown/greater than 10 years passed

MEDIUM RISK

• immediate, IgE mediated reactions
• remote history of anaphylaxis
• angioedema

PCN Skin test

HIGH RISK

• Recent anaphylaxis
• Positive penicillin skin tests
• Recurrent allergic reactions to multiple beta-lactam antibiotics

• SCARs (i.e. Stevens Johnson, Toxic Epidermal Necrolysis)

Contraindicated direct challenge

PENFAST

Trubiano JA, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020

References

1. Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022 Dec;150(6):1333-1393. doi: 10.1016/j.jaci.2022.08.028. Epub 2022 Sep 17. PMID: 36122788.2. Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin Allergy Delabeling: A Multidisciplinary Opportunity. J Allergy Clin Immunol Pract. 2020 Oct;8(9):2858-2868.e16. doi: 10.1016/j.jaip.2020.04.059. PMID: 33039010; PMCID: PMC8019188. 3. Trubiano JA, Vogrin S, Chua KYL, Bourke J, Yun J, Douglas A, Stone CA, Yu R, Groenendijk L, Holmes NE, Phillips EJ. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020 May 1;180(5):745-752. doi: 10.1001/jamainternmed.2020.0403. PMID: 32176248; PMCID: PMC7076536. 4. BC Provincial Antimicrobial Clinical Expert Group (PACE). Beta-Lactam Allergy Delabeling Guideline and Toolkit. Decemeber 15, 2021.

PCN Allergy

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