The Faculty of Medicine of the University of Hong Kong found that 2% of the population in Hong Kong was labeled as sensitive to B-lactams (B-lactams), including penicillin. However, after formal allergy assessment, 90% of patients were mislabeled as allergic to penicillin.
Li Xi, Director of the Department of Rheumatology and Clinical Immunology and Clinical Assistant Professor of the Department of Internal Medicine, Faculty of Medicine, Faculty of Medicine, HKU, said that if patients switch to other drugs or treatments for this reason, it may increase the risk of death, hospitalization time and medical expenses, and will also lead to Bacteria are multidrug resistant.
In view of this, Li Xi led a research team to launch the "Hong Kong Drug Allergy Delabeling Initiative" (HK-DADI) in 2019. Nurses from the immunology department performed "low-risk" or "low-risk" tests for suspected penicillin-sensitive patients. "Non-low risk" assessment and triage, followed by an allergy test, can remove the "penicillin sensitive" label in as little as half a day.
Of the 312 patients evaluated in the study, 280 patients were successfully delabeled.
Dr. Hei Li, Clinical Assistant Professor, Head of Rheumatology and Clinical Immunology, Department of Medicine, Faculty of Medicine, Faculty of Medicine, HKU (left) and Xueqi Guo, Senior Nurse of Hong Kong West Hospital Cluster, Hospital Authority (right), introduced the "Hong Kong Drug Sensitivity De-labelling Programme".
One in every 50 people is defined as allergic to B-lactam drugs
Li Xi said that about one in 50 Hong Kong residents in Hong Kong is labeled as allergic to B-lactam drugs, including penicillin.
But in fact 90% of patients are "completely fine" to penicillin.
He pointed out that mistakes in diagnosis, childhood allergies but "recovery" after growing up are all causes of wrong labeling, but the lack of immunology and allergy doctors in Hong Kong often "will not check (check) again (wrong label)".
Therefore, a lot of wrong labels are accumulated.
He said: "From the perspective of our doctors, penicillin will always be one of the most commonly prescribed drugs." It belongs to the first-line antibiotic drug.
Incorrect penicillin allergy labels will be very dangerous. Some patients need penicillin antibiotics very much, but the labels are "locked and unusable", resulting in unsatisfactory medical outcomes, prolonging hospital stay, and even increasing the risk of death .
In addition, overuse of broad-spectrum antibiotics can lead to multi-drug resistance in bacteria.
In Hong Kong, about one out of every 50 Hong Kong residents is labeled as allergic to B-lactam drugs, including penicillin.
But in fact 90% of patients are "completely fine" to penicillin.
(GettyImages/Vision China)
Li Xi led the research team to start the "Hong Kong Drug Sensitivity Delabelling Project" in July 2019, and the project will end in December 2021.
Guo Xueqi, a senior nurse at the Hong Kong Island West Hospital cluster of the Hospital Authority, said that the nurses in the immunology department used telephone consultations to assess and review the medical records of suspected penicillin-sensitive patients, and triage the patients into "low-risk" or "non-risk" according to the guidelines of the University of Hong Kong School of Medicine. low risk".
Those with shock allergies, angioedema, and upper respiratory tract allergies are classified as "non-low risk", while family history of penicillin allergy, or patients who have used it but have symptoms such as mild headache and rash are classified as "low risk".
Guo reminded that there are three types of people who are not suitable for this plan, including patients who are pregnant, patients who have taken drugs to suppress the immune system within four weeks, and patients who are now sensitive.
She also pointed out that if the patient is classified as "low risk", they will be scheduled to undergo a skin test at the day center and then wait for 20 minutes.
If the result is negative, you can take the diluted penicillin drug, and observe the patient for another hour to check for allergies, dyspnea, etc.
If the patient has no other special reactions, he can safely leave the day center.
The whole process only takes about 1.5 hours.
She pointed out that the nurse will also monitor whether the patient has a delayed reaction, so she will call to follow up the patient's physical reaction after 48 hours, and the patient will also be arranged to go to the clinic in that week. At that time, the nurse will check the patient's delayed reaction again and tell the patient The tag will be removed from the HA Intranet, and a doctor's letter will be issued to the patient certifying that the tag has been successfully removed.
The study evaluated 312 patients, of whom 280 were successfully delabeled.
No patients experienced serious or systemic adverse effects during or after the test.
In addition, 63 patients were able to resume penicillin use within an average of 10 months after removal of the penicillin sensitive label.
The research results have been published in the academic journal "The Journal of Allergy and Clinical Immunology: in Practice".
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