Table 2.
Characteristics of Patients Interviewed With a Penicillin Allergy
| Characteristic | N = 154 |
|---|---|
| Age, median (IQR), y | 67 (60–73) |
| Sex, No. (%) | |
| Female | 14 (9.1%) |
| Male | 140 (90.9%) |
| Race and ethnicity, No. (%) | |
| White | 93 (60.4%) |
| Black or African American | 46 (29.9%) |
| Other | 15 (9.7%) |
| Charlson Comorbidity Index score, median (IQR) | 4 (3–6) |
| Charlson Comorbidity Index components, no. (%)a | |
| Myocardial infarction | 12 (7.8%) |
| Congestive heart failure | 39 (25.3%) |
| Peripheral vascular disease | 19 (12.3%) |
| Cerebrovascular accident or transient ischemic attack | 14 (9.1%) |
| Hemiplegia | 3 (1.9%) |
| Chronic obstructive pulmonary disease | 31 (20.1%) |
| Diabetes without complications | 49 (31.8%) |
| Diabetes with end organ damage | 21 (13.6%) |
| Moderate or severe renal disease | 5 (3.2%) |
| Mild liver disease | 6 (3.9%) |
| Moderate or severe liver disease | 3 (1.9%) |
| Peptic ulcer disease | 6 (3.9%) |
| Localized solid tumor | 28 (18.2%) |
| Metastatic solid tumor | 4 (2.6%) |
| Leukemia | 0 (0.0%) |
| Lymphoma | 2 (1.3%) |
| Dementia | 1 (0.6%) |
| Rheumatic or connective tissue disease | 8 (5.2%) |
| HIV or AIDS | 2 (1.3%) |
| Reason for admission, no. (%) | |
| Infection related or treated with antibiotics | 77 (50.0%) |
| Noninfection related, no antibiotics received | 77 (50.0%) |
| Reported allergy label, no. (%) | |
| Penicillin | 141 (91.6%) |
| Amoxicillin | 12 (7.8%) |
| Amoxicillin-clavulanate | 1 (0.6%) |
| Ampicillin | 0 (0%) |
| Ampicillin-sulbactam | 0 (0%) |
| Nafcillin | 0 (0%) |
| Health professional who entered allergy, no. (%) | |
| Medical doctor | 34 (22.1%) |
| Physician assistant/nurse practitioner | 26 (16.9%) |
| Pharmacist | 26 (16.9%) |
| Nurse | 46 (29.9%) |
| Other | 22 (14.3%) |
| Observed allergic reaction, no. (%) | 4 (2.6%) |
| Patient-reported reaction, no. (%)a | |
| Unknown | 25 (16.2%) |
| Cutaneous reactionb | 78 (50.6%) |
| Swelling | 38 (24.7%) |
| Shortness of breath | 29 (18.8%) |
| Other | 21 (13.6%) |
| Gastrointestinal side effects | 6 (3.9%) |
| Anaphylaxis | 3 (1.9%) |
| Treatment given for reaction, no. (%) | |
| Yes | 53 (34.4%) |
| No | 20 (13.0%) |
| Unknown | 81 (52.6%) |
| Timing since index reaction, no. (%) | |
| Unknown | 4 (2.6%) |
| <5 y | 5 (3.2%) |
| 5–10 y | 2 (1.3%) |
| >10 y | 143 (92.9%) |
| Concurrent antibiotic allergies listed, median (IQR) | 0 (0–0) |
| Concurrent nonantibiotic allergies listed, median (IQR) | 1 (0–2) |
| Risk stratification, no. (%)c | |
| No increased risk | 27 (17.5%) |
| Intolerance history | 3 (1.9%) |
| Low risk | 75 (48.7%) |
| Moderate-high risk | 48 (31.2%) |
| Very high risk | 1 (0.6%) |
| PEN-FASTd score | |
| 0 points | 16 (10.4%) |
| 1–2 points | 85 (55.2%) |
| 3 points | 52 (33.8%) |
| 4–5 points | 1 (0.6%) |
Abbreviations: IQR, interquartile range.
aCategories are not mutually exclusive because patients may have had more than 1 comorbidity or symptom listed; percentages may add to more than 100%.
bWe included acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis in this category; however, no patients verbally reported this diagnosis in our cohort.
cPatients with confirmed safe receipt of any penicillin-class antibiotic other than piperacillin/tazobactam after the index date were classified as “no increased risk.” Those who received piperacillin-tazobactam were reclassified as “no increased risk” only if the original history was consistent with a low-risk allergy.
dThe PEN-FAST score is a penicillin allergy clinical decision rule, the points being as follows: PEN, penicillin allergy reported by patient; F, 5 y or less since reaction (2 points); A, anaphylaxis or angioedema (2 points); S, severe cutaneous adverse reaction (2 points); T, treatment required for reaction (1 point). 0 points: very low risk of positive penicillin allergy test (<1%); 1–2 points: low risk (5%); 3 points: moderate risk (20%); 4–5 points: high risk (50%).