Authors (including presenting author) :
Wong CYJ (1), Kan AKC (1), Chik TSH (2), Chu MY (3), Ho GCH (4), Li TCM(5), Au EYL (6), Li PH (1)
Affiliation :
(1) Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
(2) Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong
(3) Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
(4) Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
(5) Division of Infectious Diseases, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong
(6) Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong
Introduction :
Penicillin allergies are prevalent but are largely over-diagnosed. To overcome the magnitude of penicillin labels and the lack of specialists, there is increasing interest for non-allergists to perform allergy testing in low-risk cases. Under the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI), a multidisciplinary team consisting of the allergists and non-allergists corroborated on a set of consensus statements for allergy testing by non-allergists for low-risk penicillin allergies. HK-DADI have previously demonstrated the safety and effectiveness of a nurse-led, protocol-driven evaluation in penicillin allergy delabelling. To assess the role of non-allergists in the implementation of HK-DADI, a “Hub-and-Spokes” model was adopted whereby nurses triaged patients with penicillin allergies into low-risk and non-low risk. Low-risk cases were seen at a nurse-led clinic, with either an allergist on site at the “Hub”, or a non-allergist at a “Spoke”.
Objectives :
To assess the role of non-allergists in the implementation of HK-DADI through a “Hub-and-Spokes” model and compare the effectiveness and safety of penicillin delabelling under this model.
Methodology :
A multicentre, cross-sectional study was conducted at four tertiary hospitals (one Hub and three Spokes) in Hong Kong. Patients triaged into low-risk penicillin allergies underwent complete allergological workup. Demographics and clinical outcomes were compared between the Hub-and-Spokes.
Result & Outcome :
Results: Among 244 patients with penicillin allergy labels, 228 (93.4%) completed workup; 75 (32.9%) from the Hub and 153 (67.1%) from the Spoke. Only fourteen (6.1%) patients were diagnosed with a genuine penicillin allergy. Delabelling rates of Hub and Spokes were similar (94.7% vs 94.1%, p=0.867). The duration of carrying an allergy label were similar between the Hub-and-Spokes (10.4±5.7 vs 8.9±7.2 years, p=0.278, respectively). No patients developed severe or systemic reactions during evaluation. On multivariate analysis, patients assessed at the Spokes had more concomitant drug allergies (76.0% vs 36.6%, p< 0.013), encountered more difficulties in prescription of antibiotics (86.7% vs 39.9%, p< 0.001) and required more clinic attendances (2.07±0.71 vs 1.15±0.40, p< 0.001) compared to the Hub. Duration between referral and first consultation (i.e., clinic waiting time) was significantly shorter at the Spokes compared with Hub (0.67 vs 15.7 months, p>0.001).
Conclusion: The HK-DADI Hub-and-Spokes model proved penicillin allergy delabelling to be safe and effective, with comparable outcomes between non-allergists and allergist. This robust model should be adopted in low-risk cases as it safely mitigated the need for all drug allergy assessments to be carried out by an allergist and significantly cut specialist clinic waiting time.
