The safety and feasibility of an oral test-dose challenge to assess low-risk penicillin allergy in critically ill hospital patients.

Abstract

Penicillin allergies are a major burden on patients and hospitals. Currently, up to 1 in 4 Australian patients admitted to hospital will report an antibiotic allergy, many of which limit appropriate antibiotic usage and lead to inferior health outcomes. In many instances, patients will report what is considered a “low-risk” penicillin allergy and are appropriate for a penicillin re-challenge (i.e. a simple test dose) to determine if they are still allergic. We have developed assessment tools and a protocol for performing this test dose which has been safe and effective in over 98% of Austin inpatients. However, at present the safety and efficacy of performing oral penicillin re-challenge in the intensive care unit (ICU) setting is unknown, despite significant potential benefits to patients. This study will determine if penicillin oral re-challenge can be feasibly and safely performed in a small number of ICU patients to allow for future studies to examine the potential benefits of such testing in a larger group of patients.