PDF(Pubmed)
Abstract：
UNASSIGNED: To improve β-lactam delabeling outcomes, we need to understand current practice and the evidence base regarding its outcomes, safety, and impact.
UNASSIGNED: We sought to assess the existing published evidence reporting on the effectiveness of penicillin allergy testing and delabeling.
UNASSIGNED: We conducted a systematic review of studies reporting β-lactam delabeling practices and outcomes after testing, including β-lactam use and patient understanding of the delabeling result. Searches of the PubMed, Scopus, and Embase databases; clinical trial registries; and websites of professional organizations were conducted. Data were extracted from the included studies in duplicate, with a third extraction if discrepancies remained.
UNASSIGNED: We included 284 publications (covering 98,316 participants); 173 were prospective studies, with no randomized controlled trials. The overall study quality was low. In all, 95.6% of individuals who underwent provocation testing were delabeled. Factors associated with successful delabeling could not be determined because of significant heterogeneity between studies. Anaphylaxis due to testing occurred in 0.3% of participants (95 of 31,667). Subjects who did not undergo skin testing (6,980 patients in 31 studies) before challenge had higher rates of provocation test positivity (8.8% vs 4.1% [P < .0001]) and anaphylaxis (15.9% vs 2.7% [P < .0001]) than those subjects who underwent skin testing (51,607 patients in 177 studies). Six studies (2.1%) followed patients after testing to assess their adherence to prescribing recommendations. In all, 136 participants (20.6%) were actively avoiding β-lactams despite delabeling.
UNASSIGNED: The available data suggest that penicillin allergy testing is safe and effective in delabeling most individuals, but the evidence base is incomplete and more work is required to assess the role of skin testing and the impact that delabeling is having on prescribing habits.
UNASSIGNED: We sought to assess the existing published evidence reporting on the effectiveness of penicillin allergy testing and delabeling.
UNASSIGNED: We conducted a systematic review of studies reporting β-lactam delabeling practices and outcomes after testing, including β-lactam use and patient understanding of the delabeling result. Searches of the PubMed, Scopus, and Embase databases; clinical trial registries; and websites of professional organizations were conducted. Data were extracted from the included studies in duplicate, with a third extraction if discrepancies remained.
UNASSIGNED: We included 284 publications (covering 98,316 participants); 173 were prospective studies, with no randomized controlled trials. The overall study quality was low. In all, 95.6% of individuals who underwent provocation testing were delabeled. Factors associated with successful delabeling could not be determined because of significant heterogeneity between studies. Anaphylaxis due to testing occurred in 0.3% of participants (95 of 31,667). Subjects who did not undergo skin testing (6,980 patients in 31 studies) before challenge had higher rates of provocation test positivity (8.8% vs 4.1% [P < .0001]) and anaphylaxis (15.9% vs 2.7% [P < .0001]) than those subjects who underwent skin testing (51,607 patients in 177 studies). Six studies (2.1%) followed patients after testing to assess their adherence to prescribing recommendations. In all, 136 participants (20.6%) were actively avoiding β-lactams despite delabeling.
UNASSIGNED: The available data suggest that penicillin allergy testing is safe and effective in delabeling most individuals, but the evidence base is incomplete and more work is required to assess the role of skin testing and the impact that delabeling is having on prescribing habits.
摘要：
■为了改善β-内酰胺去标签结果，我们需要了解当前的实践和有关其结果的证据基础，安全,和影响。
■我们试图评估现有发表的关于青霉素过敏测试和去标签有效性的证据报告。
我们对报告β-内酰胺脱标签实践和测试后结果的研究进行了系统回顾，包括β-内酰胺的使用和患者对去标签结果的理解。搜索PubMed,Scopus,和Embase数据库;临床试验注册;和专业组织的网站进行了。数据从纳入的研究中提取，一式两份，如果仍然存在差异，则进行第三次提取。
■我们纳入了284篇出版物（涵盖98,316名参与者）；173项是前瞻性研究，没有随机对照试验。总体研究质量较低。总之,95.6％接受挑衅测试的人被去标签。由于研究之间的显着异质性，无法确定与成功剥离相关的因素。0.3%的参与者(31,667人中有95人)发生了因测试引起的过敏反应。攻击前未进行皮肤测试的受试者（31项研究中的6,980例患者）的激发试验阳性率（8.8％vs4.1％[P<.0001]）和过敏反应（15.9％vs2.7％[P<.0001]）高于进行皮肤测试的受试者（177项研究中的51,607例患者）。六项研究（2.1％）在测试后跟踪患者，以评估他们对处方建议的依从性。总之,136名参与者（20.6％）积极避免β-内酰胺，尽管去标签。
■现有数据表明，青霉素过敏测试对大多数人的脱标签是安全有效的，但是证据基础不完整，需要更多的工作来评估皮肤测试的作用以及去标签对处方习惯的影响。
■我们试图评估现有发表的关于青霉素过敏测试和去标签有效性的证据报告。
我们对报告β-内酰胺脱标签实践和测试后结果的研究进行了系统回顾，包括β-内酰胺的使用和患者对去标签结果的理解。搜索PubMed,Scopus,和Embase数据库;临床试验注册;和专业组织的网站进行了。数据从纳入的研究中提取，一式两份，如果仍然存在差异，则进行第三次提取。
■我们纳入了284篇出版物（涵盖98,316名参与者）；173项是前瞻性研究，没有随机对照试验。总体研究质量较低。总之,95.6％接受挑衅测试的人被去标签。由于研究之间的显着异质性，无法确定与成功剥离相关的因素。0.3%的参与者(31,667人中有95人)发生了因测试引起的过敏反应。攻击前未进行皮肤测试的受试者（31项研究中的6,980例患者）的激发试验阳性率（8.8％vs4.1％[P<.0001]）和过敏反应（15.9％vs2.7％[P<.0001]）高于进行皮肤测试的受试者（177项研究中的51,607例患者）。六项研究（2.1％）在测试后跟踪患者，以评估他们对处方建议的依从性。总之,136名参与者（20.6％）积极避免β-内酰胺，尽管去标签。
■现有数据表明，青霉素过敏测试对大多数人的脱标签是安全有效的，但是证据基础不完整，需要更多的工作来评估皮肤测试的作用以及去标签对处方习惯的影响。
