Episode 953: Penicillin Allergies
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Episode 953: Penicillin Allergies
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Narrateur(s):
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Auteur(s):
À propos de cet audio
Contributor: Geoff Hogan MD
Educational Pearls:
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Penicillin allergies are relatively uncommon despite their frequent reports
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10% of the population reports a penicillin allergy but only 5% of these cases are clinically significant
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90-95% of patients may tolerate a rechallenge after appropriate allergy evaluation
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Penicillin Allergy Decision Rule (PEN-FAST) on MD Calc
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Useful tool to assess patients for penicillin allergies
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Five years or less since reaction = 2 points (even if unknown)
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Anaphylaxis or angioedema OR Severe cutaneous reaction = 2 points
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Treatment required for reaction (e.g. epinephrine) = 1 point (even if unknown)
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A score of 0 on PEN-FAST indicates a less than 1% risk of a positive penicillin allergy test
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A score of 1 or 2 indicates a 5% risk of a positive penicillin allergy test
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A low score on PEN-FAST should prompt clinicians to proceed with the best empiric antibiotic for the patient’s infection
References
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Broyles AD, Banerji A, Barmettler S, et al. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):603. doi: 10.1016/j.jaip.2020.10.025.] [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):605. doi: 10.1016/j.jaip.2020.11.036.]. J Allergy Clin Immunol Pract. 2020;8(9S):S16-S116. doi:10.1016/j.jaip.2020.08.006
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Piotin A, Godet J, Trubiano JA, et al. Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule [published correction appears in Ann Allergy Asthma Immunol. 2022 Jun;128(6):740. doi: 10.1016/j.anai.2022.04.005.]. Ann Allergy Asthma Immunol. 2022;128(1):27-32. doi:10.1016/j.anai.2021.07.005
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Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188-199. doi:10.1001/jama.2018.19283
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Trubiano JA, Vogrin S, Chua KYL, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020;180(5):745-752. doi:10.1001/jamainternmed.2020.0403
Summarized & edited by Jorge Chalit, OMS3
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