The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and a committee of experts and key stakeholders have developed this guideline for the evaluation and testing of patients with an unsubstantiated label of penicillin allergy. The guideline is intended for UK clinicians who are not trained in allergy or immunology, but who wish to develop a penicillin allergy de-labelling service for their patients. It is intended to supplement the BSACI 2015 guideline \"Management of allergy to penicillin and other beta-lactams\" and therefore does not detail the epidemiology or aetiology of penicillin allergy, as this is covered extensively in the 2015 guideline (1). The guideline is intended for use only in patients with a label of penicillin allergy and does not apply to other beta-lactam allergies. The recommendations include a checklist to identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists. There are separate sections for adults and paediatrics within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy.

暂无摘要。

While opioids represent one of the most common medication allergy labels, these labels are often unsubstantiated in clinical practice. The removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain. The current approach to patients with pseudo-allergy to opioids is switching to an alternative opioid with less histamine release. Thus, allergy labels to relatively lower potency opioids such as codeine may be feasibly result in the prescription of stronger medications like fentanyl that would otherwise not be indicated.This narrative review provides an overview of the epidemiology and clinical manifestations of opioid allergy labels commonly encountered by pain management practitioners along with recommendations for evaluation and management.A literature search of PubMed was performed using the comprehensive MeSH term, \"Opioid Allergy\".In recent years, it has become apparent that a substantial proportion of patients labeled as opioid allergic are found to be tolerant of these agents. Opioid skin testing and IgE assays are of limited application. DPT is the yet underutilized gold standard for diagnosis. There is also an increasing call for studies evaluating basophil activation testing in opiate allergy.Opioid allergy labels require a closer look especially in view of the current opioid epidemic. The low likelihood of true reactivity, combined with the conceivable clinical relevance of an opioid allergy label, calls for further characterization of this label in populations with acute or chronic pain diagnoses. Future directions should include larger prospective studies with systematic evaluation and classification of opioid allergy labels to determine future viability of opioid use.AbbreviationsEHRelectronic health recordNMBAneuromuscular blocking agentIgEimmunoglobulin EMCmast cellGPCRG-protein coupled receptorMRGPRX2mas-related G-protein receptorQAIquaternary ammonium ionsSCARsevere cutaneous adverse reactionAGEPacute generalized exanthematous pustulosisSDRIFEsymmetrical drug-related intertriginous and flexural exanthemaBATbasophil activation testingDPTdrug provocation testing.

暂无摘要。

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.