998. Challenging Penicillin Allergies: Pharmacist led program in a community hospital

Abstract

BackgroundPenicillin (PCN) allergy has been approximated to be reported in 10% of the United States population. Studies utilizing PCN skin testing have demonstrated that less than 1% of the population have a true PCN allergy. With increasing data on the negative consequences associated with a PCN allergy diagnosis, correctly identifying these patients is imperative. PCN skin testing has resulted in high rates of penicillin de-labeling; however, there are limited data evaluating the impact of a pharmacist-led PCN allergy evaluation with removal through utilization of oral challenges. The aim of this study was to utilize pharmacists to correctly identify those who are not penicillin-allergic to help decrease unnecessary use of broad-spectrum antibiotics and to optimize therapy.MethodsThis is a single-center, prospective review looking at a 10-month period of a pharmacist-led de-labeling project of patients with a PCN allergy. The electronic medical record system and decision support software were used to identify eligible patients. Adults ≥18 years of age with a PCN allergy were included. During the evaluation, pharmacists utilized a series of standardized questions which was reviewed with the infectious disease physician to classify the patient’s allergy. Based on classification a protocol was followed that either led to the patient retaining their allergy, or removal. The primary objective is to evaluate the rate of removal of penicillin allergies. Secondary objectives reviewed removal rate of patients on active antibiotics, and evaluate how many were switched to β-lactam.ResultsA total of 492 patients with PCN allergies were interviewed by a pharmacist. Pharmacist de-labeled 99/492 (20%) PCN allergies. Of those patients, 23% were removed through oral challenge and 76% through patient history. There were 175 patients on active antibiotics and 52/175 (30%) had their allergies removed. Finally, 36/52 (69%) were switched to a β-lactam.ConclusionA pharmacist-led penicillin allergy de-labeling project is beneficial in reducing PCN allergies when skin testing is unavailable in community hospitals. As seen about 1 in 5 patients were able to remove their allergy through allergy evaluation or oral challenge. Furthermore, pharmacist evaluation of the allergy not only helped remove the allergy but also resulted in the most appropriate antibiotic. Disclosures All authors: No reported disclosures.