Abstract：
Among patients with hematopoietic stem cell transplants, infections, particularly multidrug-resistant infections, pose a grave threat. In this setting, penicillin allergy labels are both common and harmful. Though the majority of patients who report penicillin allergy can actually tolerate penicillin, penicillin allergy labels are associated with use of alternative antibiotics, which are often more broad spectrum, less effective, and more toxic. In turn, they are associated with more severe infections, multidrug-resistant infections, Clostridium difficile, and increased mortality. Evaluating penicillin allergy labels can immediately expand access to preferred therapeutic options, which are critical to care in patients with recent hematopoietic stem cell transplants. Point-of-care assessment and clinical decision tools now exist to aid the nonallergist in assessment of penicillin allergy. This can aid in expanding use of other beta-lactam antibiotics and assist in risk-stratifying patients to determine a testing strategy. In patients with low-risk reaction histories, direct oral challenges can be employed to efficiently delabel patients across clinical care settings. We advocate for multidisciplinary efforts to evaluate patients with penicillin allergy labels prior to transplantation.
摘要：
在造血干细胞移植的患者中，感染,尤其是多重耐药感染，构成严重威胁。在此设置中，青霉素过敏标签既常见又有害。尽管大多数报告青霉素过敏的患者实际上可以耐受青霉素，青霉素过敏标签与使用替代抗生素有关，通常是更宽的光谱，不太有效,毒性更大。反过来,它们与更严重的感染有关，多药耐药感染，艰难梭菌,和死亡率增加。评估青霉素过敏标签可以立即扩大对首选治疗方案的访问，这对最近进行造血干细胞移植的患者的护理至关重要。现在存在即时评估和临床决策工具，以帮助非过敏症患者评估青霉素过敏。这可以帮助扩大其他β-内酰胺抗生素的使用，并有助于对患者进行风险分层以确定测试策略。在有低风险反应史的患者中，直接口服挑战可以用于有效地在临床护理环境中删除患者。我们提倡多学科努力评估移植前青霉素过敏标签的患者。
