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      Penicillin Allergy and Perioperative Anaphylaxis


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          Penicillin allergy is the most commonly reported drug allergy, while perioperative anaphylaxis is overall rare. This review covers the epidemiology of both penicillin allergy and perioperative anaphylaxis both separately and taken together. Considerations regarding anaphylaxis to penicillin during pregnancy are also discussed, since penicillin is the drug of choice for Group B Streptococcus prophylaxis. The minimal cross reactivity between penicillins and cephalosporins is addressed, since the vast majority of patients with a penicillin allergy label can receive perioperative cephalosporins. The management of the patient who has experienced perioperative anaphylaxis, including the importance of allergy referral is covered. Approaches to pre-operative penicillin allergy evaluations and opportunities for education are highlighted.

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            American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.

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              Health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: A cohort study.

              Penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate. We sought to determine total hospital days, antibiotic exposures, and the prevalence rates of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in patients with and without penicillin "allergy" at hospital admission. We performed a retrospective, matched cohort study of subjects admitted to Kaiser Foundation hospitals in Southern California during 2010 through 2012. It was possible to match 51,582 (99.6% of all possible cases) unique hospitalized subjects with penicillin "allergy" to 2 unique discharge diagnosis category-matched, sex-matched, age-matched, and date of admission-matched control subjects each. Cases with penicillin "allergy" averaged 0.59 (9.9%; 95% CI, 0.47-0.71) more total hospital days during 20.1 ± 10.5 months of follow-up compared with control subjects. Cases were treated with significantly more fluoroquinolones, clindamycin, and vancomycin (P < .0001) for each antibiotic compared with control subjects. Cases had 23.4% (95% CI, 15.6% to 31.7%) more C difficile, 14.1% (95% CI, 7.1% to 21.6%) more MRSA, and 30.1% (95% CI, 12.5% to 50.4%) more VRE infections than expected compared with control subjects. A penicillin "allergy" history, although often inaccurate, is not a benign finding at hospital admission. Subjects with a penicillin "allergy" history spend significantly more time in the hospital. Subjects with a penicillin "allergy" history are exposed to significantly more antibiotics previously associated with C difficile and VRE. Drug "allergies" in general, but most those notably to penicillin, are associated with increased hospital use and increased C difficile, MRSA, and VRE prevalence. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

                Author and article information

                Front Allergy
                Front Allergy
                Front. Allergy
                Frontiers in Allergy
                Frontiers Media S.A.
                09 June 2022
                : 3
                : 903161
                [1] 1Rochester Regional Health , Rochester, NY, United States
                [2] 2Clinical Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry , Rochester, NY, United States
                Author notes

                Edited by: Mariana C. Castells, Brigham and Women's Hospital and Harvard Medical School, United States

                Reviewed by: Vito Sabato, University of Antwerp, Belgium; Gerald Wayne Volcheck, Mayo Clinic, United States; David Hepner, Mass General Brigham, United States

                *Correspondence: Allison Ramsey allison.ramsey@ 123456rochesterregional.org

                This article was submitted to Drug, Venom &amp; Anaphylaxis, a section of the journal Frontiers in Allergy

                Copyright © 2022 Ramsey.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 24 March 2022
                : 10 May 2022
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 52, Pages: 6, Words: 4989

                penicillin allergy,perioperative anaphylaxis,penicillin skin testing,pregnancy,preoperative,cephalosporin—drug


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