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Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis

Derek Paul Gateman, Jessie Erin Rumble, Jennifer L.P. Protudjer and Harold Kim
April 16, 2021 9 (2) E394-E399; DOI: https://doi.org/10.9778/cmajo.20200077
Derek Paul Gateman
Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children’s Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.
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Jessie Erin Rumble
Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children’s Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.
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Jennifer L.P. Protudjer
Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children’s Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.
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Harold Kim
Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children’s Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.
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    Figure 1:

    Protocol for eligibility for oral provocation challenge, using the self-reported results from the patient intake form (Appendix 2, available at www.cmajopen.ca/content/9/2/E394/suppl/DC1).

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    Table 1:

    World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System (20)

    GradeSymptoms or signs
    1Cutaneous, upper respiratory (rhinitis, throat clearing, cough), conjunctival or other (nausea, metallic taste or headache)
    2More than 1 organ system, lower respiratory, gastrointestinal, or uterine cramps
    3Lower respiratory or upper respiratory (laryngeal, uvula or tongue edema)
    4Respiratory failure or cardiovascular (hypotension)
    5Death
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    Table 2:

    Demographic characteristics of patients who were included in the study

    CharacteristicNo. (%) of included patients*†
    n = 99
    Sex
     Male27 (27)
     Female72 (73)
    Age, yr; mean ± SD (n = 98)28.3 ± 21.1
    Age < 18 yr41 (42)
     Mean8.0 ± 4.1
    Age ≥ 18 yr57 (58)
     Mean42.9 ± 15.5
    Wait time, d; mean ± SD (n = 97)59.0 ± 69.8
    Wait time < 45 d53 (54)
     Mean18.0 ± 13.8
    Wait time ≥ 45 d46 (44)
     Mean108.4 ± 78.0
    Family history of penicillin allergy (n = 97)
     No80 (83)
     Yes17 (17)
    Personal history of immediate reaction to penicillin (n = 90)
     No81 (90)
     Yes9 (10)
    • Note: SD = standard deviation.

    • ↵* Unless specified otherwise.

    • ↵† Observations with missing information on a characteristic were excluded from the relevant analysis.

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CMAJ Open: 9 (2)
Vol. 9, Issue 2
1 Apr 2021
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Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis
Derek Paul Gateman, Jessie Erin Rumble, Jennifer L.P. Protudjer, Harold Kim
Apr 2021, 9 (2) E394-E399; DOI: 10.9778/cmajo.20200077

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Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis
Derek Paul Gateman, Jessie Erin Rumble, Jennifer L.P. Protudjer, Harold Kim
Apr 2021, 9 (2) E394-E399; DOI: 10.9778/cmajo.20200077
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