青霉素的二级预防旨在防止急性风湿热的进一步发作和随后的风湿性心脏病(RHD)的发展。青霉素过敏,10%的人口自我报告,会影响二级预防计划。我们旨在评估(i)常规青霉素过敏测试的作用以及(ii)在这种情况下青霉素过敏剥离方法的安全性。我们搜索了MEDLINE,Embase,中部,ClinicalTrials.gov,世卫组织ICTRP,ISRCTN,和CPCI-S确定相关报告。我们找到了2419条记录,但是没有研究解决我们最初的问题。根据世卫组织准则委员会和专家的建议,我们确定了6份针对其他人群的变态反应测试手稿,这些手稿显示通过测试确认的变态反应患病率较低,对BPG的危及生命反应的发生率非常低(<1-3/1000接受治疗的个体).随后的搜索解决了青霉素过敏脱标签。发现516条记录,和5项研究解决了直接口服药物攻击的安全性与对怀疑青霉素过敏的患者进行皮肤测试,然后给药。在少数患者中观察到轻微严重程度的即时过敏反应,在直接药物攻击组中发生频率较低:2.3%vs.11.5%;RR=0.25,95CI0.15-0.45,P<0.00001,I2=0%。没有观察到过敏反应或死亡。对青霉素的严重过敏反应极为罕见,可以由训练有素的医护人员识别和处理。使用直接口服药物激发或青霉素皮肤测试确认青霉素过敏诊断或脱标签似乎是安全的,并且不良反应发生率低。
Secondary prevention with
penicillin aims to prevent further episodes of acute rheumatic fever and subsequent development of rheumatic heart disease (RHD). Penicillin allergy, self-reported by 10% of the population, can affect secondary prevention programs. We aimed to assess the role for (i) routine
penicillin allergy testing and the (ii) safety of
penicillin allergy delabeling approaches in this context. We searched MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, ISRCTN, and CPCI-S to identify the relevant reports. We found 2419 records, but no studies addressed our initial question. Following advice from the WHO-
Guideline committee and experts, we identified 6 manuscripts on allergy testing focusing on other populations showing that the prevalence of allergy confirmed by testing was low and the incidence of life-threatening reactions to BPG was very low (< 1-3/1000 individuals treated). A subsequent search addressed
penicillin allergy delabeling. This found 516 records, and 5 studies addressing the safety of direct oral drug challenge vs. skin testing followed by drug administration in patients with suspected penicillin allergy. Immediate allergic reactions of minor severity were observed for a minority of patients and occurred less frequently in the direct drug challenge group: 2.3% vs. 11.5%; RR = 0.25, 95%CI 0.15-0.45, P < 0.00001, I2 = 0%. No anaphylaxis or deaths were observed. Severe allergic reactions to penicillin are extremely rare and can be recognized and dealt by trained healthcare workers. Confirmation of
penicillin allergy diagnosis or delabeling using direct oral drug challenge or
penicillin skin testing seems to be safe and is associated with a low rate of adverse reactions.