@article{SchrueferStoevesandtTrautmann2022,
  author    = {Schr{\"u}fer, Philipp and Stoevesandt, Johanna and Trautmann, Axel},
  title     = {Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing},
  series = {Allergy, Asthma \& Clinical Immunology},
  volume    = {18},
  journal   = {Allergy, Asthma \& Clinical Immunology},
  issn      = {1710-1484},
  doi       = {10.1186/s13223-022-00659-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299840},
  year      = {2022},
  abstract  = {Background Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity. Methods We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019. Results In 595 (74.4\%) out of 800 cases evaluated, β-lactam allergy could be excluded by negative challenge testing. IgE-mediated anaphylaxis was diagnosed in 70 (8.7\%) patients, delayed-type hypersensitivity in 135 (16.9\%). In 62 (88.6\%) anaphylaxis cases, the algorithm correctly advised to use an alternative antibiotic. Accuracy was higher in patients with moderate to severe anaphylaxis (97.7\%) compared to those with a history of mild reactions (73.1\%). The algorithm correctly identified 122 (90.4\%) patients with proven delayed-type hypersensitivity. It permitted de-labelling in 330 (55.5\%) out of 595 patients with diagnostic exclusion of penicillin hypersensitivity, but failed to identify the remaining 265 (44.5\%) as low-risk cases. Conclusions The algorithm detected 89.8\% of cases with penicillin (β-lactam) allergy, sensitivity was optimal for moderate to severe anaphylaxis. Study data justify the implementation of a standardized de-labelling algorithm under close supervision in order to permit guideline-directed treatment and reduce the use of broad-spectrum antibiotics as part of an antibiotic stewardship program.},
  language  = {en}
}