对开具青霉素处方的患者进行青霉素过敏测试和去标签:世界卫生组织指南的系统回顾

IF 8.4 2区 医学 Q1 ALLERGY
Rui Providencia, Ghazaleh Aali, Fang Zhu, Brian F. Leas, Rachel Orrell, Mahmood Ahmad, Jonathan J. H. Bray, Ferruccio Pelone, Petra Nass, Eloi Marijon, Miryan Cassandra, David S. Celermajer, Farhad Shokraneh
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引用次数: 0

摘要

使用青霉素进行二级预防的目的是防止再次发生急性风湿热和随后发展成风湿性心脏病(RHD)。有 10% 的人自我报告对青霉素过敏,这可能会影响二级预防计划。我们旨在评估(i) 常规青霉素过敏测试的作用和(ii) 在这种情况下青霉素过敏脱标方法的安全性。我们检索了 MEDLINE、Embase、CENTRAL、ClinicalTrials.gov、WHO ICTRP、ISRCTN 和 CPCI-S,以确定相关报告。我们找到了 2419 条记录,但没有任何研究解决了我们最初的问题。根据世卫组织指南委员会和专家的建议,我们找到了 6 篇关于过敏测试的手稿,这些手稿主要针对其他人群,显示通过测试确认的过敏发生率很低,而对 BPG 产生危及生命的反应的发生率非常低(1-3/1000)。随后的一项搜索涉及青霉素过敏的标签。结果发现了 516 条记录和 5 项研究,这些研究针对的是疑似青霉素过敏患者直接口服药物挑战与皮试后给药的安全性对比。在少数患者中观察到了轻微的即刻过敏反应,而且直接药物试验组的发生率较低:2.3% vs. 11.5%;RR = 0.25,95%CI 0.15-0.45,P < 0.00001,I2 = 0%。未发现过敏性休克或死亡病例。对青霉素的严重过敏反应极为罕见,受过培训的医护人员可以识别和处理。使用直接口服药物挑战或青霉素皮试确认青霉素过敏诊断或脱标似乎是安全的,且不良反应发生率较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline

Penicillin Allergy Testing and Delabeling for Patients Who Are Prescribed Penicillin: A Systematic Review for a World Health Organization Guideline

Secondary prevention with penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine penicillin allergy testing and the (ii) safety of penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low (< 1–3/1000 individuals treated). A subsequent search addressed penicillin allergy delabeling. This found 516 records, and 5 studies addressing the safety of direct oral drug challenge vs. skin testing followed by drug administration in patients with suspected penicillin allergy. Immediate allergic reactions of minor severity were observed for a minority of patients and occurred less frequently in the direct drug challenge group: 2.3% vs. 11.5%; RR = 0.25, 95%CI 0.15–0.45, P < 0.00001, I2 = 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of penicillin allergy diagnosis or delabeling using direct oral drug challenge or penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.

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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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