BRIEF REPORT
Siddharth Madapoosi, MD, MPH; Julio Garcia-Castro, MD; Nadia Ilhardt, MD; Mikel Llanes, MD; Rajan Ravikumar, MD; Anna McEvoy, MD; Eric Walford, MD
Corresponding Author: Siddharth Madapoosi, MD, MPH; Department of Internal Medicine, Michigan Medicine
Email: madapoos@umich.edu
DOI: 10.3122/jabfm.2024.240115R1
Keywords: Allergy and Immunology, Electronic Health Records, Follow-Up Studies, Hypersensitivity, Michigan, Penicillin, Primary Health Care
Dates: Submitted: 03-11-2024; Revised: 05-03-2024; Accepted: 05-20-2024
FINAL PUBLICATION: |HTML| |PDF|
PURPOSE: Nearly 10% of the United States population has a reported penicillin allergy. However, many of these patients do not have true IgE-mediated allergy and are exposed to alternative antibiotics with increased risks of adverse outcomes, highlighting the importance of penicillin allergy testing. Patients with very low-risk penicillin allergies can safely undergo direct oral challenge (DOC) with a therapeutic dose of amoxicillin without prior skin testing. This study sought to establish a protocol for DOC in a primary care setting and test its efficacy and safety.
METHODS: A standardized DOC protocol was developed at two primary care sites in Southeast Michigan. 49 patients across the two sites were identified as having very low-risk penicillin allergies and underwent DOC. Follow up phone calls were completed one week and six months following DOC.
RESULTS: All 49 patients had a negative DOC and successfully had their penicillin allergy de-labeled from their electronic health record (EHR). No patients reported severe adverse reactions following DOC. All 22 patients who were successfully contacted six months after completing DOC reported willingness to take penicillin if prescribed in the future and believed they were no longer allergic to penicillin.
CONCLUSIONS: The results suggest that DOC may be effectively and safely implemented in a primary care setting to de-label penicillin allergies in patients with low-risk penicillin allergies. This study may serve as a model to increase access to DOC for adults in rural settings or low-income patient populations with limited access to allergy specialists.