RESUMO
Background: Less than 5% of children who report penicillin allergy have clinically pertinent type 1 immunoglobulin E mediated hypersensitivity reaction by using direct oral amoxicillin challenge. Several pathways have been developed to delabel penicillin allergy by using direct oral amoxicillin challenge, mostly in the outpatient settings, but there is relative scarcity on published outcomes of these pathways, especially in the inpatient pediatric settings. Objective: This study aimed to evaluate the performance of an institutionally derived inpatient penicillin allergy screening tool. Methods: Patients were stratified into three penicillin allergy risk categories by using an institutional screening questionnaire. Patients with a no-risk status were delabeled without challenge testing. Patients with low-risk status underwent direct graded oral amoxicillin challenge and delabeled based on their response. Patients with high-risk status were referred to allergy service. Results: Ninety-two patients were identified with penicillin allergy. Forty of the 92 patients (43%) were screened. Of the 40 patients screened, 6 (15%) were identified as no risk, 28 (70%) were identified as low risk, and 6 (15%) were identified as high risk. Twenty-four of the 28 patients at low risk (86%) were eligible for direct amoxicillin oral challenge. Seventeen of the 24 (71%) consented to oral challenge but only 12 (71%) underwent direct amoxicillin oral challenge. Eleven of the 12 who underwent oral challenge (92%) were successfully delabeled. Five of the six patients at no risk (83%) were successfully delabeled. Three of the six patients at high risk (50%) were referred for further allergy evaluation. Overall, 16 of the 40 patients screened (40%) were successfully delabeled. Conclusion: In this small pediatric inpatient study, our institutional risk stratification screening tool identified patients at low risk for penicillin allergy and direct graded oral amoxicillin challenge was safely administered to delabel penicillin allergy in these patients.Clinical trial NCT05020327,
Assuntos
Hipersensibilidade a Drogas , Hipersensibilidade , Criança , Humanos , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Pacientes Internados , Penicilinas/efeitos adversos , Testes CutâneosAssuntos
Abscesso Abdominal/etiologia , Celulite (Flegmão)/etiologia , Imunoglobulina G/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/etiologia , Infecção dos Ferimentos/etiologia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/microbiologia , Abscesso Abdominal/patologia , Abscesso Abdominal/cirurgia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/patologia , Celulite (Flegmão)/cirurgia , Clindamicina/uso terapêutico , Terapia Combinada , Imunodeficiência de Variável Comum/terapia , Desbridamento , Substituição de Medicamentos , Feminino , Humanos , Imunoglobulina G/administração & dosagem , Imunoglobulina G/uso terapêutico , Imunoglobulinas Intravenosas , Infusões Subcutâneas/efeitos adversos , Meropeném , Pessoa de Meia-Idade , Necrose , Pioderma Gangrenoso/terapia , Reoperação , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/cirurgia , Tienamicinas/uso terapêutico , Vancomicina/uso terapêutico , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/patologiaAssuntos
Coriorretinite/etiologia , Imunodeficiência de Variável Comum/complicações , Adulto , Coriorretinopatia de Birdshot , Coriorretinite/imunologia , Imunodeficiência de Variável Comum/tratamento farmacológico , Imunodeficiência de Variável Comum/imunologia , Feminino , Antígenos HLA-A/imunologia , Humanos , Imunoglobulinas/sangue , Imunoglobulinas/uso terapêutico , Retina/patologia , gama-Globinas/uso terapêuticoRESUMO
Nocardia brain abscesses are a known occurrence in patients with immunocompromised conditions. Nocardial infection is commonly an unfortunate sequela to other complications which these patients are being followed up and treated for. The incidence of nocardial brain abscess in an otherwise healthy patient is extremely rare. We present a case of Nocardia brain abscess in a previously healthy individual, who, upon workup for vision and gait abnormalities, was shown to have multiple brain abscesses and a decreased absolute CD4(+) lymphocyte count. Adding to the rarity of our case, the finding of lymphocytopenia in our patient was unrelated to any known predisposing condition or infectious state.