{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:29:42Z","timestamp":1772166582025,"version":"3.50.1"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T00:00:00Z","timestamp":1729296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T00:00:00Z","timestamp":1729296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012285","name":"BC Children\u2019s Hospital","doi-asserted-by":"publisher","award":["BC Children\u2019s Hospital"],"award-info":[{"award-number":["BC Children\u2019s Hospital"]}],"id":[{"id":"10.13039\/100012285","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Allergy Asthma Clin Immunol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Penicillin allergy adversely impacts patient care, yet most cases do not have true allergies. Clinicians require efficient, reliable clinical tools to identify low risk patients who can be safely de-labeled. Our center implemented the FIRSTLINE electronic point-of-care decision support tool to help non-allergist practitioners risk stratify patients with penicillin allergy. We sought to explore the reliability and validity of this tool in relation to allergist assessment and actual patient outcomes. We additionally compared it with two other published stratification tools, JAMA and PENFAST, to assess ability to accurately identify low risk patients appropriate for direct oral challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center, retrospective, observational study, 181 pregnant females with self-reported penicillin allergy between July 2019 to June 2021 at BC Women\u2019s Hospital, Vancouver, Canada were used to assess the reliability and validity of all three tools. Physician-guided history of penicillin use and symptoms were used for scoring. Results and recommendations were compared to actual patient outcomes after clinician decision for direct oral challenge or intradermal tests. We compared the performance of JAMA, PENFAST and FIRSTLINE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>181 patients were assessed. 176\/181 (97.2%) patients were deemed not allergic. Each risk stratification tool labelled majority of patients as low risk with 88.4% of patients PENFAST 0\u20132, 60.2% of patients JAMA low risk, 86.7% of patients FIRSTLINE very low risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We demonstrate that our point-of-care electronic algorithm is reliable in identifying low risk pregnant patients, as compared to an allergist assessment. To our knowledge, this is the first study to provide direct comparison between multiple decision support tools using the same population, minimizing participant bias. Providing clinical algorithms to risk stratify patients, can enable healthcare professionals to safely identify individuals who may be candidates for direct penicillin oral challenges versus needing referral to specialists. This increases the generalizability and efficiency of penicillin allergy de-labeling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13223-024-00918-3","type":"journal-article","created":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T06:02:08Z","timestamp":1729317728000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-1836","authenticated-orcid":false,"given":"Joanne","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Elwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Paquette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha","family":"Kwan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Erdle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Watt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Van Schalkwyk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey N.","family":"Bone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Mak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,19]]},"reference":[{"key":"918_CR1","doi-asserted-by":"publisher","unstructured":"Macfadden DR, Ladelfa A, Leen J, et al. Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study. Clinical Infectious Diseases. 2016;63(7):904\u2013910. https:\/\/doi.org\/10.1093\/CID\/CIW462","DOI":"10.1093\/CID\/CIW462"},{"key":"918_CR2","doi-asserted-by":"publisher","unstructured":"Steenvoorden L, Bjoernestad EO, Kvesetmoen TA, Gulsvik AK. De-labelling penicillin allergy in acutely hospitalized patients: a pilot study. BMC Infect Dis. 2021;21(1):1\u20137. https:\/\/doi.org\/10.1186\/S12879-021-06794-1","DOI":"10.1186\/S12879-021-06794-1"},{"key":"918_CR3","doi-asserted-by":"publisher","unstructured":"Cooper L, Harbour J, Sneddon J, Seaton RA. Safety and efficacy of de-labelling penicillin allergy in adults using direct oral challenge: a systematic review. JAC Antimicrob Resist. 2021;3(1). https:\/\/doi.org\/10.1093\/JACAMR\/DLAA123","DOI":"10.1093\/JACAMR\/DLAA123"},{"key":"918_CR4","doi-asserted-by":"publisher","unstructured":"Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. Published online July 17, 2023. https:\/\/doi.org\/10.1001\/JAMAINTERNMED.2023.2986","DOI":"10.1001\/JAMAINTERNMED.2023.2986"},{"key":"918_CR5","doi-asserted-by":"publisher","unstructured":"Zhang BY, Paquette V, McClymont E, et al. Implementing a penicillin allergy delabeling service for the obstetric population. J Allergy Clin Immunol Pract. 2021;9(6):2501\u20132502.e2. https:\/\/doi.org\/10.1016\/J.JAIP.2021.01.023","DOI":"10.1016\/J.JAIP.2021.01.023"},{"key":"918_CR6","doi-asserted-by":"publisher","unstructured":"Roberts H, Soller L, Ng K, et al. First pediatric electronic algorithm to stratify risk of penicillin allergy. 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J Allergy Clin Immunol Pract. 2022;10(7):1919\u20131921.e1. https:\/\/doi.org\/10.1016\/J.JAIP.2022.03.025","DOI":"10.1016\/J.JAIP.2022.03.025"},{"key":"918_CR10","doi-asserted-by":"publisher","unstructured":"Fox SJ, Park MA. Penicillin skin testing is a safe and effective tool for evaluating penicillin allergy in the pediatric population. J Allergy Clin Immunol Pract. 2014;2(4):439\u2013444. https:\/\/doi.org\/10.1016\/J.JAIP.2014.04.013","DOI":"10.1016\/J.JAIP.2014.04.013"},{"key":"918_CR11","doi-asserted-by":"publisher","unstructured":"DA K, A B, KG B, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333\u20131393. https:\/\/doi.org\/10.1016\/J.JACI.2022.08.028","DOI":"10.1016\/J.JACI.2022.08.028"},{"key":"918_CR12","doi-asserted-by":"publisher","unstructured":"Del Real GA, Rose ME, Ramirez-Atamoros MT, et al. Penicillin skin testing in patients with a history of \u03b2-lactam allergy. 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JAMA. 2020;323(12):1216\u20131216. https:\/\/doi.org\/10.1001\/JAMA.2019.19809","DOI":"10.1001\/JAMA.2019.19809"}],"container-title":["Allergy, Asthma &amp; Clinical Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-024-00918-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13223-024-00918-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13223-024-00918-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T06:03:21Z","timestamp":1729317801000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacijournal.biomedcentral.com\/articles\/10.1186\/s13223-024-00918-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,19]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["918"],"URL":"https:\/\/doi.org\/10.1186\/s13223-024-00918-3","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3373805\/v1","asserted-by":"object"}]},"ISSN":["1710-1492"],"issn-type":[{"value":"1710-1492","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,19]]},"assertion":[{"value":"20 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"An ethics and consent waiver from the University of British Columbia was obtained for this quality improvement project.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Raymond Mak and Tiffany Wong with unrestricted educational grant from ALK. No other conflict of interest from other remaining authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"55"}}