A 5-year retrospective review of graded drug challenges performed in an outpatient allergy practice

Authors

David Lutz, Rochester Regional Health
Allison Ramsey, Rochester Regional Health
Kelly Conn, St. John Fisher UniversityFollow
Syed Shahzad Mustafa, Rochester Regional Health

Document Type

Conference Proceeding

Publication Date

2-2019

Abstract

Rationale

There is limited data on the characteristics and safety of graded drug challenges (GDC). This study characterizes GDCs performed at an outpatient allergy practice over a five-year period.

Methods

Patients of five allergy/immunology physicians who underwent a GDC from 2013-2018 were identified through an electronic medical record report. GDCs to penicillin-related antibiotics that were preceded by a penicillin skin testing were excluded. Patient demographics, historical reactions, purpose, and outcome of the GDC were recorded.

Results

172 GDCs were performed, of which 159 (92.4%) were negative, and 13 (7.6%) were positive. There were 67 (39%) males and 105 (61%) females, with an average age of 38.1± 28.3 years. The time since the reported ADR was 8.0 ± 13.0 years. GDCs were performed for 113 (65.7%) antibiotics, 37 (21.5%) NSAIDs, 7 (4 %) oral steroids and 15 (8.7%) other medications. The most commonly challenged antibiotics were amoxicillin (31.0%), macrolides (18.6%), cephalosporins (16.8%), and sulfamethoxazole (15.9%). Although the majority of GDCs were performed electively (51.2%), other common indications included management of recurrent infections (18.6%) and analgesia (11.0%). There was no statistically significant difference between the positive and negative challenges with respect to gender, age, time since reaction, number of drug allergies, drug challenged, or historical reaction. Of the 13 positive challenges, 10 were to antibiotics and 3 were to NSAIDs. One of 13 (7.7%) positive challenges, performed to azithromycin, required epinephrine for flushing, dyspnea, and wheezing.

Conclusions

GDCs can be safely performed in the outpatient setting and are an effective strategy for de-labeling drug allergies.

Comments

Presented at the American Academy of Allergy, Asthma, and Immunology Annual Meeting. San Francisco, CA. February 22-25, 2019

Abstract published in The Journal of Allergy and Clinical Immunology, February 2019, Volume 143, Issue 2, Supplement, AB 27.

Publication Information

Lutz, David; Ramsey, Allison; Conn, Kelly; and Mustafa, Syed Shahzad, "A 5-year retrospective review of graded drug challenges performed in an outpatient allergy practice" (2019). Pharmacy Faculty/Staff Publications. Paper 600.
https://fisherpub.sjf.edu/pharmacy_facpub/600

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