{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:33:19Z","timestamp":1789950799063,"version":"4.0.1"},"reference-count":56,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,10,27]],"date-time":"2017-10-27T00:00:00Z","timestamp":1509062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Approximately 90\u201099% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications\u2014longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to\n                    <jats:italic>Clostridium difficile<\/jats:italic>\n                    , methicillin\u2010resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    infections and vancomycin\u2010resistant enterococcus. We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the\n                    <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                    and several other countries and knowledge gaps regarding PenA amongst healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non\u2010specialists rapidly identify and de\u2010label \u201clow\u2010risk\u201d hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost\u2010effectiveness and its compatibility with information technology systems currently employed in the health service.\n                  <\/jats:p>","DOI":"10.1111\/cea.13044","type":"journal-article","created":{"date-parts":[[2017,10,13]],"date-time":"2017-10-13T12:22:39Z","timestamp":1507897359000},"page":"1362-1373","source":"Crossref","is-referenced-by-count":79,"title":["Enhancing antibiotic stewardship by tackling \u201cspurious\u201d penicillin allergy"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2109-5777","authenticated-orcid":false,"given":"M. T.","family":"Krishna","sequence":"first","affiliation":[{"name":"Department of Allergy and Immunology Birmingham Heartlands Hospital Heart of England NHS Foundation Trust Birmingham UK"},{"name":"Institute of Immunology &amp; Immunotherapy University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. P.","family":"Huissoon","sequence":"additional","affiliation":[{"name":"Department of Allergy and Immunology Birmingham Heartlands Hospital Heart of England NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Microbiology University Hospital of Coventry and Warwickshire Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Richter","sequence":"additional","affiliation":[{"name":"Clinical Immunology Service Birmingham Medical School University of Birmingham Edgbaston Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. G.","family":"Pillay","sequence":"additional","affiliation":[{"name":"Department of Microbiology Birmingham Heartlands Hospital Heart of England NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Sambanthan","sequence":"additional","affiliation":[{"name":"Tata Consultancy Services Ltd Thoraipakkam Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. C.","family":"Raman","sequence":"additional","affiliation":[{"name":"Tata Consultancy Services Ltd Thoraipakkam Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Nasser","sequence":"additional","affiliation":[{"name":"Department of Allergy Cambridge University Hospitals Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Misbah","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0000000000000173"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.18.2819"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2010.08.002"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2083"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202438"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2014.02.003"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)63589-2"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150514"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-6749(99)70439-2"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.09.021"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2222.2003.01638.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.10.032"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.02.012"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw008"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-1303-3"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-7843.2006.pto_230.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2012.33.3510"},{"key":"e_1_2_10_19_1","unstructured":"Drug Allergy: Diagnosis and Management in adults children and young people; NICE Guidelines CG183.2015."},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2008.01924.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12468"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2010.088203"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2013.02.002"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2036"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2010.08.025"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2222.2002.01296.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.2007.02867.x"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2008.01903.x"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/pai.12155"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/pai.12314"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.0033"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.12774"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.01.023"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.02.023"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12134"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2015.05.011"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.4.1106"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ394"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)61100-3"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12774"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13168"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1159\/000090502"},{"key":"e_1_2_10_43_1","unstructured":"House of Lords Science and Technology Committee.Allergy Volume 1: Report. 6th Report of session 2006\u20107."},{"key":"e_1_2_10_44_1","unstructured":"House of Commons Health Committee.The provision of Allergy Services. 6the report 2003\u20104."},{"key":"e_1_2_10_45_1","unstructured":"Royal College of Physicians.Allergy: the unmet need.2003."},{"key":"e_1_2_10_46_1","first-page":"52","article-title":"Allergy in Hong Kong: an unmet need in service provision and training","volume":"21","author":"Chan YT","year":"2015","journal-title":"Hong Kong Med J"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000006"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2016.09.045"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2017.02.005"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.02.019"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12701"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.02.014"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.02.031"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc053529"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-4-200702200-00005"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.10.007"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.07.062"}],"container-title":["Clinical &amp; Experimental Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcea.13044","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cea.13044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T06:22:28Z","timestamp":1696314148000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cea.13044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,27]]},"references-count":56,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/cea.13044"],"URL":"https:\/\/doi.org\/10.1111\/cea.13044","archive":["Portico"],"relation":{},"ISSN":["0954-7894","1365-2222"],"issn-type":[{"value":"0954-7894","type":"print"},{"value":"1365-2222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,27]]}}}