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  1. Article ; Online: Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists.

    Liu, Matthew Y / McCoul, Edward D / Brooks, Edward G / Lao, Veronica F / Chen, Philip G

    International forum of allergy & rhinology

    2023  Volume 13, Issue 6, Page(s) 973–978

    Abstract: A patient-reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin-E (IgE)-mediated allergic reaction. Unfortunately, ... ...

    Abstract A patient-reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin-E (IgE)-mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs. As physicians who treat patients of all ages for common sinonasal pathology in the clinic and operating room in addition to frequently providing testing and management of allergic diseases, rhinologists are well positioned to aid in delabeling patients with inaccurate penicillin allergies. This viewpoint highlights the consequences of inaccurate penicillin allergy designation in the clinic and perioperative period and explores misconceptions regarding cross-reactivity between penicillins and cephalosporins. Opportunities are explored for shared decision-making with colleagues in other specialties, such as anesthesiology, and practical recommendations are provided to aid rhinologists when faced with a patient who holds a questionable history of penicillin allergy. Rhinologists can play an active role in delabeling patients with inaccurate penicillin allergies with the goal of ensuring appropriate antibiotic use for future medical encounters.
    MeSH term(s) Humans ; Penicillins/adverse effects ; Anti-Bacterial Agents/adverse effects ; Drug Hypersensitivity/diagnosis ; Drug Hypersensitivity/epidemiology ; Drug Hypersensitivity/therapy ; Cephalosporins/adverse effects ; Hypersensitivity
    Chemical Substances Penicillins ; Anti-Bacterial Agents ; Cephalosporins
    Language English
    Publishing date 2023-05-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2625826-2
    ISSN 2042-6984 ; 2042-6976
    ISSN (online) 2042-6984
    ISSN 2042-6976
    DOI 10.1002/alr.23173
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis.

    Liu, Matthew Y / Challa, Megana / McCoul, Edward D / Chen, Philip G

    The Laryngoscope

    2022  Volume 133, Issue 5, Page(s) 1086–1091

    Abstract: Objective: Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site ... ...

    Abstract Objective: Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery.
    Methods: A break-even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR.
    Results: Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability.
    Conclusion: In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery.
    Level of evidence: NA Laryngoscope, 133:1086-1091, 2023.
    MeSH term(s) Humans ; Clindamycin/adverse effects ; Penicillins/adverse effects ; Anti-Bacterial Agents/adverse effects ; Antibiotic Prophylaxis/adverse effects ; Retrospective Studies ; Drug Hypersensitivity/diagnosis ; Drug Hypersensitivity/etiology ; Drug Hypersensitivity/prevention & control ; Surgical Wound Infection/prevention & control ; Hypersensitivity/complications
    Chemical Substances Clindamycin (3U02EL437C) ; Penicillins ; Anti-Bacterial Agents
    Language English
    Publishing date 2022-07-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.30329
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: SNOT-22 Quality of Life Scores Improve After Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea.

    Liu, Matthew Y / Woodworth, Bradford A / Kanaan, Alissa / Jang, David W / Yao, William C / Radabaugh, Jeffrey Paul / Gardner, James Reed / Goros, Martin / Grayson, Jessica W / Wang, Zhu / Chen, Philip G

    The Annals of otology, rhinology, and laryngology

    2022  Volume 132, Issue 9, Page(s) 1077–1084

    Abstract: Objectives: Patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea can experience significant sinonasal symptom burden, leading to poor quality of life (QOL). The objective of this study was to investigate sinonasal outcome test-22 (SNOT-22) ... ...

    Abstract Objectives: Patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea can experience significant sinonasal symptom burden, leading to poor quality of life (QOL). The objective of this study was to investigate sinonasal outcome test-22 (SNOT-22) scores in patients undergoing endoscopic endonasal surgery for spontaneous CSF rhinorrhea and compare them to patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP).
    Methods: A multi-institutional retrospective review of patients with spontaneous CSF rhinorrhea and CRSsNP was performed. Pre-surgery and post-surgery SNOT-22 scores and domains were compared within each group. Improvements in SNOT-22 scores after surgery were compared between the groups.
    Results: Ninety-one patients were in the CSF rhinorrhea group and 105 patients were in the CRSsNP group. Within each group, surgery significantly improved total SNOT-22 scores, domain scores, and most of the individual symptoms. Comparing the 2 groups revealed similar improvements in total SNOT-22 scores (
    Conclusions: Patients with spontaneous CSF rhinorrhea experience significant symptom burden. Those who undergo CSF leak repair should experience significant improvement in QOL similar to patients who undergo ESS for CRSsNP as measured by SNOT-22.
    MeSH term(s) Humans ; Sino-Nasal Outcome Test ; Cerebrospinal Fluid Rhinorrhea/surgery ; Quality of Life ; Rhinitis/complications ; Rhinitis/surgery ; Rhinitis/diagnosis ; Nose ; Endoscopy ; Nasal Polyps/surgery ; Sinusitis/complications ; Sinusitis/surgery ; Sinusitis/diagnosis ; Chronic Disease ; Treatment Outcome
    Language English
    Publishing date 2022-11-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120642-4
    ISSN 1943-572X ; 0003-4894
    ISSN (online) 1943-572X
    ISSN 0003-4894
    DOI 10.1177/00034894221133769
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps.

    Liu, Matthew Y / Gardner, James Reed / Woodworth, Bradford A / Jang, David W / Kanaan, Alissa / Radabaugh, Jeffrey Paul / Yao, William C / Goros, Martin / Challa, Megana / Grayson, Jessica W / Wang, Zhu / Chen, Philip G

    The Annals of otology, rhinology, and laryngology

    2022  Volume 132, Issue 6, Page(s) 698–704

    Abstract: Objectives: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)- ...

    Abstract Objectives: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP).
    Methods: A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared.
    Results: One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (
    Conclusions: Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.
    MeSH term(s) Humans ; Nasal Polyps/diagnosis ; Cerebrospinal Fluid Rhinorrhea/diagnosis ; Sino-Nasal Outcome Test ; Nasal Obstruction ; Retrospective Studies ; Rhinitis/complications ; Rhinitis/diagnosis ; Chronic Disease ; Sinusitis/complications ; Sinusitis/diagnosis ; Facial Pain ; Rhinorrhea ; Quality of Life
    Language English
    Publishing date 2022-07-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120642-4
    ISSN 1943-572X ; 0003-4894
    ISSN (online) 1943-572X
    ISSN 0003-4894
    DOI 10.1177/00034894221111256
    Database MEDical Literature Analysis and Retrieval System OnLINE

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