Session Type: ePosters
Session Title: ePosters
Authors(s): M. Rose (1, 2), S. Vogrin (3), N. Holmes (1, 4, 5), K. Chua (1), G. Drewett (1), A. Douglas (1, 2), J. Trubiano (1, 2, 6)
Authors Affiliations(s): (1) Centre for Antibiotic Allergy and Research, Austin Health, Australia, (2) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Australia, (3) Department of Medicine (St Vincent's Health), University of Melbourne, Australia, (4) Department of Critical Care, The University of Melbourne, Australia, (5) Data Analytics Research and Evaluation Centre, Austin Health and The University of Melbourne, Australia, (6) Department of Medicine (Austin Health), The University of Melbourne, Australia
Background:
“Sulfonamides” are one of the most commonly reported antibiotic allergies and restrict the administration of trimethoprim/sulfamethoxazole (Co-T), particularly in immunocompromised patients. Unfortunately, the efficacy of traditional skin testing in sulfonamide allergy is unclear and access to formal allergy assessment can be limited. Direct oral Co-T challenge could offer a safe and efficacious alternative.
Methods:Patients aged ≥18 years referred to drug and antibiotic allergy services at a tertiary hospital and a quaternary cancer hospital (Melbourne, Australia) were prospectively enrolled in an antibiotic allergy assessment database. We identified patients with a reported sulfonamide allergy label, described their allergy phenotype (risk stratified as per previously published criteria) and assessed the safety and efficacy of sulfonamide allergy testing including direct oral Co-T challenge.
Results:180/1857 (9.7%) patients reported allergies to sulfonamides (155 (8.3%) to Co-T). Allergy phenotypes included 26 (14%) suspected IgE-mediated immediate reactions, 99 (55%) suspected T-cell mediated delayed reactions and 39 (22%) immune mechanism unspecified. 45 (25%) reactions required treatment, and 40 (22%) necessitated hospitalisation. 44/99 (44%) delayed phenotypes underwent subsequent patch testing, with 4 (9%) positive tests identified. 32/155 (21%) patients (59% female, median age 64 years, 53% immunosuppressed, median charlson comorbidity index 3.5) received a direct oral challenge with Co-T 400/80 mg. 30 of 32 (94%) challenges were tolerated and the allergy label was removed. Two positive challenges were identified: one rapid-onset urticarial rash over the trunk and arms without systemic features which resolved with oral anti-histamine therapy, and one delayed-onset (during post-challenge Co-T therapy) mild maculopapular exanthem that resolved with cessation of Co-T.
Conclusions:Data from this prospective cohort confirms the frequency of reported sulfonamide allergy and the commonly identified allergy phenotypes. This, alongside skin and oral challenge data, suggests that direct oral challenge is safe in low-risk trimethoprim/sulfamethoxazole allergy and offers a path to accessible Co-T allergy assessment.
Keyword(s): Allergy, Antibiotic, HypersensitivitySession Type: ePosters
Session Title: ePosters
Authors(s): M. Rose (1, 2), S. Vogrin (3), N. Holmes (1, 4, 5), K. Chua (1), G. Drewett (1), A. Douglas (1, 2), J. Trubiano (1, 2, 6)
Authors Affiliations(s): (1) Centre for Antibiotic Allergy and Research, Austin Health, Australia, (2) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Australia, (3) Department of Medicine (St Vincent's Health), University of Melbourne, Australia, (4) Department of Critical Care, The University of Melbourne, Australia, (5) Data Analytics Research and Evaluation Centre, Austin Health and The University of Melbourne, Australia, (6) Department of Medicine (Austin Health), The University of Melbourne, Australia
Background:
“Sulfonamides” are one of the most commonly reported antibiotic allergies and restrict the administration of trimethoprim/sulfamethoxazole (Co-T), particularly in immunocompromised patients. Unfortunately, the efficacy of traditional skin testing in sulfonamide allergy is unclear and access to formal allergy assessment can be limited. Direct oral Co-T challenge could offer a safe and efficacious alternative.
Methods:Patients aged ≥18 years referred to drug and antibiotic allergy services at a tertiary hospital and a quaternary cancer hospital (Melbourne, Australia) were prospectively enrolled in an antibiotic allergy assessment database. We identified patients with a reported sulfonamide allergy label, described their allergy phenotype (risk stratified as per previously published criteria) and assessed the safety and efficacy of sulfonamide allergy testing including direct oral Co-T challenge.
Results:180/1857 (9.7%) patients reported allergies to sulfonamides (155 (8.3%) to Co-T). Allergy phenotypes included 26 (14%) suspected IgE-mediated immediate reactions, 99 (55%) suspected T-cell mediated delayed reactions and 39 (22%) immune mechanism unspecified. 45 (25%) reactions required treatment, and 40 (22%) necessitated hospitalisation. 44/99 (44%) delayed phenotypes underwent subsequent patch testing, with 4 (9%) positive tests identified. 32/155 (21%) patients (59% female, median age 64 years, 53% immunosuppressed, median charlson comorbidity index 3.5) received a direct oral challenge with Co-T 400/80 mg. 30 of 32 (94%) challenges were tolerated and the allergy label was removed. Two positive challenges were identified: one rapid-onset urticarial rash over the trunk and arms without systemic features which resolved with oral anti-histamine therapy, and one delayed-onset (during post-challenge Co-T therapy) mild maculopapular exanthem that resolved with cessation of Co-T.
Conclusions:Data from this prospective cohort confirms the frequency of reported sulfonamide allergy and the commonly identified allergy phenotypes. This, alongside skin and oral challenge data, suggests that direct oral challenge is safe in low-risk trimethoprim/sulfamethoxazole allergy and offers a path to accessible Co-T allergy assessment.
Keyword(s): Allergy, Antibiotic, Hypersensitivity
National Centre for Infections In Cancer
Session Type: ePosters
Session Title: ePosters
Authors(s): M. Rose (1, 2), S. Vogrin (3), N. Holmes (1, 4, 5), K. Chua (1), G. Drewett (1), A. Douglas (1, 2), J. Trubiano (1, 2, 6)
Authors Affiliations(s): (1) Centre for Antibiotic Allergy and Research, Austin Health, Australia, (2) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Australia, (3) Department of Medicine (St Vincent's Health), University of Melbourne, Australia, (4) Department of Critical Care, The University of Melbourne, Australia, (5) Data Analytics Research and Evaluation Centre, Austin Health and The University of Melbourne, Australia, (6) Department of Medicine (Austin Health), The University of Melbourne, Australia
Background:
“Sulfonamides” are one of the most commonly reported antibiotic allergies and restrict the administration of trimethoprim/sulfamethoxazole (Co-T), particularly in immunocompromised patients. Unfortunately, the efficacy of traditional skin testing in sulfonamide allergy is unclear and access to formal allergy assessment can be limited. Direct oral Co-T challenge could offer a safe and efficacious alternative.
Methods:Patients aged ≥18 years referred to drug and antibiotic allergy services at a tertiary hospital and a quaternary cancer hospital (Melbourne, Australia) were prospectively enrolled in an antibiotic allergy assessment database. We identified patients with a reported sulfonamide allergy label, described their allergy phenotype (risk stratified as per previously published criteria) and assessed the safety and efficacy of sulfonamide allergy testing including direct oral Co-T challenge.
Results:180/1857 (9.7%) patients reported allergies to sulfonamides (155 (8.3%) to Co-T). Allergy phenotypes included 26 (14%) suspected IgE-mediated immediate reactions, 99 (55%) suspected T-cell mediated delayed reactions and 39 (22%) immune mechanism unspecified. 45 (25%) reactions required treatment, and 40 (22%) necessitated hospitalisation. 44/99 (44%) delayed phenotypes underwent subsequent patch testing, with 4 (9%) positive tests identified. 32/155 (21%) patients (59% female, median age 64 years, 53% immunosuppressed, median charlson comorbidity index 3.5) received a direct oral challenge with Co-T 400/80 mg. 30 of 32 (94%) challenges were tolerated and the allergy label was removed. Two positive challenges were identified: one rapid-onset urticarial rash over the trunk and arms without systemic features which resolved with oral anti-histamine therapy, and one delayed-onset (during post-challenge Co-T therapy) mild maculopapular exanthem that resolved with cessation of Co-T.
Conclusions:Data from this prospective cohort confirms the frequency of reported sulfonamide allergy and the commonly identified allergy phenotypes. This, alongside skin and oral challenge data, suggests that direct oral challenge is safe in low-risk trimethoprim/sulfamethoxazole allergy and offers a path to accessible Co-T allergy assessment.
Keyword(s): Allergy, Antibiotic, HypersensitivitySession Type: ePosters
Session Title: ePosters
Authors(s): M. Rose (1, 2), S. Vogrin (3), N. Holmes (1, 4, 5), K. Chua (1), G. Drewett (1), A. Douglas (1, 2), J. Trubiano (1, 2, 6)
Authors Affiliations(s): (1) Centre for Antibiotic Allergy and Research, Austin Health, Australia, (2) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Australia, (3) Department of Medicine (St Vincent's Health), University of Melbourne, Australia, (4) Department of Critical Care, The University of Melbourne, Australia, (5) Data Analytics Research and Evaluation Centre, Austin Health and The University of Melbourne, Australia, (6) Department of Medicine (Austin Health), The University of Melbourne, Australia
Background:
“Sulfonamides” are one of the most commonly reported antibiotic allergies and restrict the administration of trimethoprim/sulfamethoxazole (Co-T), particularly in immunocompromised patients. Unfortunately, the efficacy of traditional skin testing in sulfonamide allergy is unclear and access to formal allergy assessment can be limited. Direct oral Co-T challenge could offer a safe and efficacious alternative.
Methods:Patients aged ≥18 years referred to drug and antibiotic allergy services at a tertiary hospital and a quaternary cancer hospital (Melbourne, Australia) were prospectively enrolled in an antibiotic allergy assessment database. We identified patients with a reported sulfonamide allergy label, described their allergy phenotype (risk stratified as per previously published criteria) and assessed the safety and efficacy of sulfonamide allergy testing including direct oral Co-T challenge.
Results:180/1857 (9.7%) patients reported allergies to sulfonamides (155 (8.3%) to Co-T). Allergy phenotypes included 26 (14%) suspected IgE-mediated immediate reactions, 99 (55%) suspected T-cell mediated delayed reactions and 39 (22%) immune mechanism unspecified. 45 (25%) reactions required treatment, and 40 (22%) necessitated hospitalisation. 44/99 (44%) delayed phenotypes underwent subsequent patch testing, with 4 (9%) positive tests identified. 32/155 (21%) patients (59% female, median age 64 years, 53% immunosuppressed, median charlson comorbidity index 3.5) received a direct oral challenge with Co-T 400/80 mg. 30 of 32 (94%) challenges were tolerated and the allergy label was removed. Two positive challenges were identified: one rapid-onset urticarial rash over the trunk and arms without systemic features which resolved with oral anti-histamine therapy, and one delayed-onset (during post-challenge Co-T therapy) mild maculopapular exanthem that resolved with cessation of Co-T.
Conclusions:Data from this prospective cohort confirms the frequency of reported sulfonamide allergy and the commonly identified allergy phenotypes. This, alongside skin and oral challenge data, suggests that direct oral challenge is safe in low-risk trimethoprim/sulfamethoxazole allergy and offers a path to accessible Co-T allergy assessment.
Keyword(s): Allergy, Antibiotic, Hypersensitivity