Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

L C Savic¹, D A Khan², P Kopac³, R C Clarke⁴, P J Cooke⁵, P Dewachter⁶, D G Ebo⁷, T Garcez⁸, L H Garvey⁹, A B Guttormsen¹⁰, P M Hopkins¹¹, D L Hepner¹², H Kolawole¹³, M Krøigaard¹⁴, J J Laguna¹⁵, S D Marshall¹³, P M Mertes¹⁶, P R Platt⁴, M A Rose¹⁷, V Sabato⁷, P H M Sadleir¹⁸, S Savic¹⁹, T Takazawa²⁰, S Voltolini²¹, G W Volcheck²²

Affiliations

¹ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: louise.savic@nhs.net.
² Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
³ University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
⁴ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia.
⁵ Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
⁶ Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France.
⁷ Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
⁸ Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
⁹ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹¹ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
¹² Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
¹⁴ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark.
¹⁵ Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain.
¹⁶ Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
¹⁷ Department of Anaesthesia, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia.
¹⁸ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
¹⁹ Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
²⁰ Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
²¹ Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy.
²² Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.

PMID: 30916014
DOI: 10.1016/j.bja.2019.01.026

Free article

Review

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

L C Savic et al. Br J Anaesth. 2019 Jul.

Free article

. 2019 Jul;123(1):e82-e94.

doi: 10.1016/j.bja.2019.01.026. Epub 2019 Mar 11.

Authors

Affiliations

¹ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: louise.savic@nhs.net.
² Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
³ University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
⁴ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia.
⁵ Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
⁶ Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France.
⁷ Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
⁸ Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
⁹ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹¹ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
¹² Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
¹⁴ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark.
¹⁵ Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain.
¹⁶ Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
¹⁷ Department of Anaesthesia, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia.
¹⁸ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
¹⁹ Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
²⁰ Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
²¹ Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy.
²² Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.

PMID: 30916014
DOI: 10.1016/j.bja.2019.01.026

Abstract

Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

Keywords: allergy; drug provocation testing; penicillin; prophylaxis; surgery; surgical site infection.

PubMed Disclaimer

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
- Elsevier Science
- Ovid Technologies, Inc.
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Affiliations

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical