Year: 2024
Type: article
Abstract: PURPOSE: Nearly 10% of the United States population has a reported penicillin allergy. However, many of these patients do not have true IgE-mediated allergy and are exposed to alternative antibiotics with increased risks of adverse outcomes, highlighting the importance of penicillin allergy testing. Patients with very low-risk penicillin allergies can safely undergo direct oral challenge (DOC) with a therapeutic dose of amoxicillin without prior skin testing. This study sought to establish a protocol for DOC in a primary care setting and test its efficacy and safety. METHODS: A standardized DOC protocol was developed at 2 primary care sites in Southeast Michigan. Forty-nine patients across the 2 sites were identified as having very low-risk penicillin allergies and underwent DOC. Follow up phone calls were completed 1 week and 6 months following DOC. RESULTS: All 49 patients had a negative DOC and successfully had their penicillin allergy delabeled from their electronic health record (EHR). No patients reported severe adverse reactions following DOC. All 22 patients who were successfully contacted 6 months after completing DOC reported willingness to take penicillin if prescribed in the future and believed they were no longer allergic to penicillin. CONCLUSIONS: The results suggest that DOC may be effectively and safely implemented in a primary care setting to delabel penicillin allergies in patients with low-risk penicillin allergies. This study may serve as a model to increase access to DOC for adults in rural settings or low-income patient populations with limited access to allergy specialists.
Institutions: University of Michigan, Michigan Medicine
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408715882