Joaquín Quiralte , María del Robledo Ávila , Isabel Domínguez , Estela Menéndez , José Miguel Cisneros , Ana Belén Guisado
{"title":"β-内酰胺过敏标签的取消既安全又能节省初级保健费用","authors":"Joaquín Quiralte , María del Robledo Ávila , Isabel Domínguez , Estela Menéndez , José Miguel Cisneros , Ana Belén Guisado","doi":"10.1016/j.aprim.2024.102925","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To determine whether the β-lactam allergy delabeling was safe and cost-saving in Primary Care (PC) patients.</p></div><div><h3>Design</h3><p>We have conducted a retrospective chart review of PC patients with β-lactam allergy label evaluated in our Allergy Unit between 2017 and 2022.</p></div><div><h3>Site</h3><p>Allergy Department. Hospital Virgen del Rocio (Sevilla).</p></div><div><h3>Participants</h3><p>A total of 391 patients labeled for β-lactam allergy in PC were studied.</p></div><div><h3>Main measurements</h3><p>(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.</p></div><div><h3>Results</h3><p>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 €, <em>p</em> <!--><<!--> <!-->10<sup>−3</sup>), than that observed in truly allergic group (0.87 € vs. 0.76 €, <em>p</em> <!-->=<!--> <!-->not significant).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":55435,"journal":{"name":"Atencion Primaria","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0212656724000672/pdfft?md5=cb45e8ed29a4a5aae35682cad1d62a09&pid=1-s2.0-S0212656724000672-main.pdf","citationCount":"0","resultStr":"{\"title\":\"β-Lactam allergy delabeling is safe and saves costs in Primary Care\",\"authors\":\"Joaquín Quiralte , María del Robledo Ávila , Isabel Domínguez , Estela Menéndez , José Miguel Cisneros , Ana Belén Guisado\",\"doi\":\"10.1016/j.aprim.2024.102925\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To determine whether the β-lactam allergy delabeling was safe and cost-saving in Primary Care (PC) patients.</p></div><div><h3>Design</h3><p>We have conducted a retrospective chart review of PC patients with β-lactam allergy label evaluated in our Allergy Unit between 2017 and 2022.</p></div><div><h3>Site</h3><p>Allergy Department. Hospital Virgen del Rocio (Sevilla).</p></div><div><h3>Participants</h3><p>A total of 391 patients labeled for β-lactam allergy in PC were studied.</p></div><div><h3>Main measurements</h3><p>(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.</p></div><div><h3>Results</h3><p>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 €, <em>p</em> <!--><<!--> <!-->10<sup>−3</sup>), than that observed in truly allergic group (0.87 € vs. 0.76 €, <em>p</em> <!-->=<!--> <!-->not significant).</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":55435,\"journal\":{\"name\":\"Atencion Primaria\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-05-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0212656724000672/pdfft?md5=cb45e8ed29a4a5aae35682cad1d62a09&pid=1-s2.0-S0212656724000672-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Atencion Primaria\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0212656724000672\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Atencion Primaria","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0212656724000672","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
β-Lactam allergy delabeling is safe and saves costs in Primary Care
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.
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.
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