The impact of penicillin allergy de-labelling on the WHO AWaRe antibiotic categories: a retrospective cohort study

The WHO’s AWaRe classification categorises antibiotics into three stewardship groups: Access, Watch and Reserve. The Access group includes antibiotics with lower resistance potential than antibiotics in the other two groups. The UK 5-year AMR strategy has set targets for reducing non-Access Bio Med Frontiers antibiotic use.
The majority of penicillins are in the Access group and therefore patients with a penicillin allergy record are likely to receive more non-Access antibiotics. This study aimed to quantify the impact of penicillin allergy records on non-Access antibiotic prescribing and to estimate potential reductions in non-Access antibiotic use through penicillin allergy de-labelling.
 Inpatients of a 750 patient bed UK district general hospital in England prescribed antibiotics between 1st April 2018 and 31st March 2019 were included. Variables included: age, sex, co-morbidity, infection treated, antibiotic usage, hospital length of stay, penicillin allergy status.
Multivariable logistic regression was used to explore the association between patient characteristics and their receipt of antibiotics in the Access and non-Access groups.
67,059 antibiotic prescriptions for 23,356 inpatients were analyzed. Penicillin allergy records were present in 14.3% of hospital admissions.
Patients with a penicillin allergy record were around four times more likely (OR=4.7) to receive an antibiotic from the non-Access groups (i.e. Reserve and Watch groups).
We estimate de-labelling 50% of hospital inpatients with a penicillin allergy record could reduce non-Access antibiotic use by 5.8% and total antibiotic use by 0.86%.
 Penicillin allergy records are associated with non-Access antibiotic prescribing. Penicillin allergy de-labelling has potential to reduce non-Access antibiotic use.
AWARE classification; Penicillin allergy; antimicrobial stewardship.

Category of Allergy Identification from Free-Text Medical Records for Data Interoperability.

The use of different data formats complicates the standardization and exchange of valuable medical data. Moreover, a big part of medical data is stored as unstructured medical records that are complicated to process.
In this work we solve the task of unstructured allergy anamnesis categorization according to categories Study More provided by FHIR. We applied two stage classification model with manually labeled records.
In the first stage the model filters records with information about allergies and on the second stage it categorizes each record.
The model showed high performance. The development of this approach will ensure secondary use of data and interoperability.

Delayed hypersensitivity to new oral anticoagulants. Demonstration of cross reactivity for the drug category and definition of non-irritant concentrations for patch tests.

The current therapy with direct trombin inhibitors (DTI) is indicated for the prevention of stroke in non-valvular atrial fibrillation. Side effects are reported, particularly skin hypersensitivity, for this whole category of drugs as well as for other modern antiplatelet and anticoagulant drugs.
For their clinical features, these reactions appear as delayed T-cell mediated drug hypersensitivity, but at present there are no diagnostic methods of investigation.
We reported a case of delayed skin reaction to edoxaban and we found the non-irritant concentration for patch test in the whole category of drugs. The patch test resulted positive for edoxaban. A successive challenge with alternative DTIs and/or a switch to warfarin is proposed as alternative therapy.
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Learning to Detect Triggers of Airway Symptoms: The Role of Illness Beliefs, Conceptual Categories and Actual Experience with Allergic Symptoms.

  • In asthma and allergic rhinitis, beliefs about what triggers allergic reactions often do not match objective allergy tests. This may be due to insensitivity for expectancy violations as a result of holding trigger beliefs based on conceptual relationships among triggers.
  • In this laboratory experiment, we aimed to investigate how pre-existing beliefs and conceptual relationships among triggers interact with actual experience when learning differential symptom expectations.  Healthy participants (N = 48) received information that allergic reactions were a result of specific sensitivities versus general allergic vulnerability.
  • Next, they performed a trigger learning task using a differential conditioning paradigm: brief inhalation of CO2 enriched air was used to induce symptoms, while participants were led to believe that the symptoms came about as a result of inhaled allergens (conditioned stimuli, CS’s; CS+ followed by symptoms, CS- not followed by symptoms). CS+ and CS- stimuli either shared (e.g., birds-mammals) or did not share (e.g. birds-fungi) category membership.
  • During Acquisition, participants reported symptom expectancy and symptom intensity for all triggers. During a Test 1 day later, participants rated symptom expectancies for old CS+/CS- triggers, for novel triggers within categories, and for exemplars of novel trigger categories.
  • Data were analyzed using multilevel models. Findings: Only a subgroup of participants (n = 22) showed differences between CO2 and room air symptoms. In this group of responders, analysis of symptom expectancies during acquisition did not result in significant differential symptom CS+/CS- acquisition.
  • A retention test 1 day later showed differential CS+/CS- symptom expectancies: When CS categories did not share category membership, specific sensitivity beliefs improved retention of CS+/CS- differentiation. However, when CS categories shared category membership, general vulnerability beliefs improved retention of CS+/CS- differentiation.
  • Furthermore, participants showed some selectivity in generalization of symptom expectancies to novel categories, as symptom expectancies did not generalize to novel categories that were unrelated to CS+ or CS- categories. Generalization to novel categories was not affected by information about general vulnerability or specific sensitivities.
  • Pre-existing vulnerability beliefs and conceptual relationships between trigger categories influence differential symptom expectancies to allergic triggers.

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