Comparing pharmacists versus allergists in low-risk penicillin allergy delabelling: The Hong Kong Penicillin Allergy Pharmacist Initiative (HK-PAPI)

IF 3.9 2区医学 Q2 ALLERGY World Allergy Organization Journal Pub Date : 2024-11-21 DOI:10.1016/j.waojou.2024.101003

James K.Y. Hooi MBChB , Marshall C.H. Low BPharm , Jonathan C.L. To BPharm , Hugo W.F. Mak MBBS , Mandy M. Choi BPharm , Chris C.P. Tam BPharm , Raymond W.M. Mak MSc , Vincent K.C. Wong MPharm , Timo C.C. Chan MClinPharm , Andrew W.T. Li MClinPharm , Charlie C.Y. Mak MClinPharm , Valerie Chiang MBBS , Gordon K.H. Chu MBBS , Jane C.Y. Wong MBBS , Philip H. Li MD

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Abstract

Background

Mislabelled penicillin allergies are associated with a myriad of adverse outcomes and development of anti-microbial resistance. With the overwhelming need for specialist allergy services, pharmacist initiatives such as the Hong Kong Penicillin Allergy Pharmacist Initiative (HK-PAPI) have been advocated. However, evidence of their effectiveness, safety and impact on health-related quality-of-life (HR-QoL) are lacking.

To assess and compare the effectiveness, safety and improvements on HR-QoL of pharmacists vs allergists in a pilot low-risk penicillin allergy delabelling initiative.

Methods

All adult patients referred for low-risk penicillin allergy were randomized and evaluated by either pharmacists or allergists in a 1:3 ratio. Outcomes and changes in Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q) scores were compared.

Results

Of 323 patients referred, 96.3% (311/323) completed penicillin allergy evaluation (pharmacists: 83 [24.3%] vs allergists: 228 [66.7%]). Overall, 93.6% (291/311) were delabelled with no difference between evaluations by pharmacists and allergists (92.8% vs 93.9%, p = 0.729). There were no severe or systemic reactions in either cohort. Patients evaluated by either pharmacists (43.4 [SD:29.1] to 10.5 [SD:5.93], p < 0.001) or allergists (37.2 [SD:22.2] to 29.1 [SD:22.4], p < 0.001) reported improved HR-QoL as reflected by DrHy-Q scores. However, absolute changes in DrHy-Q scores were significantly greater among patients evaluated by pharmacists compared to those by allergists (−24.6 [SD:25.1] vs −9.19 [SD:13.7], p < 0.001).

Conclusions

Evaluations and delabelling by pharmacists (vs allergists) were comparably effective and safe among patients with low-risk penicillin allergy. Moreover, patients evaluated by pharmacists even reported significantly greater improvements in HR-QoL, highlighting the potential of multidisciplinary allergy initiatives.

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比较药剂师与过敏症专科医生在低风险青霉素过敏脱敏中的作用：香港青霉素过敏药剂师计划 (HK-PAPI)

背景对青霉素过敏与多种不良后果和抗微生物抗药性的产生有关。由于对过敏专科服务的巨大需求，药剂师倡议，如香港青霉素过敏药剂师倡议（HK-PAPI）已被提倡。方法对所有转诊的低风险青霉素过敏成人患者进行随机分组，由药剂师或过敏学家按照 1:3 的比例进行评估。结果在转诊的 323 名患者中，96.3%（311/323）的患者完成了青霉素过敏评估（药剂师：83 [24.3%] vs 过敏症专家：228 [66.7%]）。总体而言，93.6%（291/311）的患者被除名，药剂师和过敏学家的评估结果无差异（92.8% vs 93.9%，p = 0.729）。两组患者均未出现严重或全身性反应。由药剂师（43.4 [SD:29.1] 对 10.5 [SD:5.93], p <0.001）或过敏症专家（37.2 [SD:22.2] 对 29.1 [SD:22.4], p <0.001）评估的患者的 HR-QoL 均有所改善，DrHy-Q 评分反映了这一点。结论在低风险青霉素过敏症患者中，由药剂师（与过敏症专家）进行评估和脱敏治疗的效果和安全性相当。此外，接受药剂师评估的患者甚至在 HR-QoL 方面有明显改善，这凸显了多学科过敏措施的潜力。

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来源期刊

World Allergy Organization Journal Immunology and Microbiology-Immunology

CiteScore

9.10

自引率

5.90%

发文量

审稿时长

9 weeks

期刊介绍： The official pubication of the World Allergy Organization, the World Allergy Organization Journal (WAOjournal) publishes original mechanistic, translational, and clinical research on the topics of allergy, asthma, anaphylaxis, and clincial immunology, as well as reviews, guidelines, and position papers that contribute to the improvement of patient care. WAOjournal publishes research on the growth of allergy prevalence within the scope of single countries, country comparisons, and practical global issues and regulations, or threats to the allergy specialty. The Journal invites the submissions of all authors interested in publishing on current global problems in allergy, asthma, anaphylaxis, and immunology. Of particular interest are the immunological consequences of climate change and the subsequent systematic transformations in food habits and their consequences for the allergy/immunology discipline.