β-Lactam allergy delabeling is safe and saves costs in Primary Care

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Atencion Primaria Pub Date : 2024-05-24 DOI:10.1016/j.aprim.2024.102925

Joaquín Quiralte , María del Robledo Ávila , Isabel Domínguez , Estela Menéndez , José Miguel Cisneros , Ana Belén Guisado

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引用次数: 0

Abstract

Objective

To determine whether the β-lactam allergy delabeling was safe and cost-saving in Primary Care (PC) patients.

Design

We have conducted a retrospective chart review of PC patients with β-lactam allergy label evaluated in our Allergy Unit between 2017 and 2022.

Site

Allergy Department. Hospital Virgen del Rocio (Sevilla).

Participants

A total of 391 patients labeled for β-lactam allergy in PC were studied.

Main measurements

(a) Outcome evaluation of a β-lactam allergy delabeling procedure. (b) A ratio between the total e-prescribed antibiotic cost and the number of treatment days (the experimental daily antibiotic cost or EDAC) before and after delabeling was analyzed in delabeled and truly allergic patients.

Results

The results of skin testing were positive in 9.2% of the reported cases (36 of 391 patients). The reactions to oral provocation challenge (OPC) occurred in 2.14% of the patients who underwent negative skin testing to offending β-lactam (in 15 of 699 OPC). A total of 307 patients (78.5%) were delabeled; 70 (17.9%) had a β-lactam selective response and 14 (3.59%) reacted to both penicillin and cephalosporin. The EDAC before and after the procedure in delabeled patients was significantly lower (0.88 € vs 0.62 €, p < 10⁻³), than that observed in truly allergic group (0.87 € vs. 0.76 €, p = not significant).

Conclusion

To delabel β-lactam allergy in Primary Care patients is safe in most patients, cost-saving in antibioticotherapy, and allows identify the main clinical β-lactam allergy phenotypes that benefit from this procedure.

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β-内酰胺过敏标签的取消既安全又能节省初级保健费用

目的确定对初级保健（PC）患者解除β-内酰胺过敏标签是否安全且节省费用。设计我们对 2017 年至 2022 年期间在过敏科接受β-内酰胺过敏标签评估的 PC 患者进行了回顾性病历审查。主要测量指标（a）β-内酰胺过敏脱标程序的结果评估。(b) 分析脱标和真正过敏患者脱标前后电子处方抗生素总费用与治疗天数（实验性每日抗生素费用或 EDAC）之间的比率。在对违禁 β-内酰胺类药物皮试呈阴性的患者中，有 2.14% 的患者（699 例 OPC 中的 15 例）出现了口服激发挑战（OPC）反应。共有 307 名患者（78.5%）被除标；70 名患者（17.9%）对 β-内酰胺有选择性反应，14 名患者（3.59%）对青霉素和头孢菌素均有反应。结论在初级保健患者中消除对β-内酰胺过敏的标签对大多数患者来说是安全的，节省了抗生素治疗的成本，并能确定从这一过程中获益的主要临床β-内酰胺过敏表型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Atencion Primaria 医学-医学：内科

CiteScore

2.90

自引率

8.00%

发文量

156

审稿时长

33 days

期刊介绍： Atención Primaria es una revista que publica trabajos de investigación relativos al ámbito de la atención primaria de salud. Desde el punto de vista conceptual, Atención Primaria asume el nuevo modelo de atención primaria de salud, orientado no sólo a la curación de la enfermedad, sino también a su prevención y a la promoción de la salud, tanto en el plano individual como en el de la familia y la comunidad. En estos nuevos aspectos que definen el modelo de atención primaria de salud es en los que se centran los trabajos de investigación que publica Atención Primaria, la primera revista de originales española creada para recoger y difundir la producción científica realizada desde los centros de atención primaria de salud sobre cuestiones como protocolización de la asistencia, programas de prevención, seguimiento y control de pacientes crónicos, organización y gestión de la asistencia primaria, entre otros.