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Prospective Assessment of Penicillin Allergy (PAPA): Evaluating the performance of penicillin allergy testing and post-delabelling outcomes among Hong Kong Chinese.
Asian Pacific Journal of Allergy and Immunology ( IF 5 ) Pub Date : 2023-04-17 , DOI: 10.12932/ap-270922-1469 Tin Sum Li 1 , Harris K S Hui 1 , Andy Ka Chun Kan 1 , Maegan H Y Yeung 1 , Jane C Y Wong 1 , Valerie Chiang 2 , Philip Hei Li 1
Asian Pacific Journal of Allergy and Immunology ( IF 5 ) Pub Date : 2023-04-17 , DOI: 10.12932/ap-270922-1469 Tin Sum Li 1 , Harris K S Hui 1 , Andy Ka Chun Kan 1 , Maegan H Y Yeung 1 , Jane C Y Wong 1 , Valerie Chiang 2 , Philip Hei Li 1
Affiliation
BACKGROUND
Incorrect penicillin 'allergy' labels predispose patients to adverse outcomes but are under-recognised in many Asian countries. Studies on performance and post-delabelling outcomes of penicillin allergy evaluation among Chinese remain scarce.
OBJECTIVE
To evaluate the diagnostic performance of allergy testing and post-delabelling outcomes among Chinese patients in a prospective penicillin allergy cohort - Prospective Assessment of Penicillin Allergy (PAPA).
METHODS
All adult patients (age ≥ 18 years) who underwent penicillin allergy evaluation between January 2020 to December 2021 were recruited and prospectively reviewed by both medical records and individual interviews at least 6 months after delabelling or allergy confirmation.
RESULTS
Out of 372 patients who completed penicillin allergy evaluation, 335 (90%) patients were delabelled. The overall negative predictive value of penicillin skin testing was 95%, but lower for patients with non-immediate type reactions (88%). History of non-immediate symptom onset (OR = 4.501 [95%CI = 2.085-9.716], p < 0.001) and duration since index reaction (OR = 0.942 [95%CI = 0.899-0.987], p = 0.012) were associated with positive skin testing. After at least 6 months, 60 (18%) of de-labelled patients had received penicillins again without any adverse reactions. Fluoroquinolone-use was significantly lower among delabelled patients compared to those with penicillin allergy (38[11%] vs 11[30%], p = 0.004).
CONCLUSIONS
After at least 6 months, one in six delabelled patients already received penicillins again safely, with significantly lower fluoroquinolone usage. None experienced adverse reactions. History of non-immediate onset and shorter duration since index reaction were associated with genuine allergy. In patients with severe non-immediate reactions, skin tests should be supplemented with thorough clinical history and adjunct diagnostic evaluations.
更新日期：2023-04-17
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