Effectiveness of Interventions to Maintain Penicillin Allergy Label Removal As Part of an Inpatient Penicillin Allergy Testing Protocol

Patel, Sheenal V.; Tarver, Scott A.; Alvarez, Kristin; Lutek, Kristin E.; Schlebus, James; Khan, David A.

doi:10.1016/j.jaci.2016.12.597

Cited by 7 publications

(5 citation statements)

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“…9 In fact, it is estimated that 36% to 49% of patients with negative penicillin testing results may have a persistence or redocumentation of their allergy despite proven negative testing results. [147][148][149] Current evidence reveals that an interactive and electronically accessible drug allergy box in a medical record that is regularly reconciled improves the management of patients labeled with drug allergies. In 1 study, the electronic medical record was used proactively to identify patients for testing, which was then performed in the inpatient unit by a trained pharmacist.…”

Section: Antibiotic Stewardship Programsmentioning

confidence: 99%

“…150 Researchers in another small pilot study prevented redocumentation with several interventions, including an electronic alert notifying providers when a penicillin allergy is added back for a patient with documented negative testing results. 148 Targeting prospective antibiotic allergy management in adults has led to a positive impact on antibiotic use and appropriateness. 151 periods among an internal medicine service and showed that inpatient skin testing to β-lactam drugs directed by an allergist and the use of previously adopted, computerized guidelines resulted in an increase in penicillin and cephalosporin use.…”

Section: Antibiotic Stewardship Programsmentioning

confidence: 99%

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Antibiotic Allergy in Pediatrics

et al. 2018

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The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.

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Section: Antibiotic Stewardship Programsmentioning

confidence: 99%

Section: Antibiotic Stewardship Programsmentioning

confidence: 99%

Antibiotic Allergy in Pediatrics

et al. 2018

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“…It is important to input the date and results of PST into the patient’s problem list and insert a placeholder in the allergy section of the EMR with the same information in an effort to prevent relabeling of the penicillin allergy. Some institutions also have the capability to add in an electronic alert that will appear if a provider is entering a penicillin allergy in the allergy section of a patient’s chart who previously had a negative PST [40,41]. In order to further assist in the prevention of penicillin allergy relabeling, PST programs need to take a multi-faceted approach that involves communication to patient and their families, providers within and outside the healthcare network, and community pharmacies.…”

Section: Penicillin Allergy Documentationmentioning

confidence: 99%

“…If this step is omitted and a patient presents to the pharmacy with a prescription for a beta-lactam antibiotic with a penicillin allergy listed in the patient profile, a potentially unnecessary phone call will be made by the pharmacist to the provider to clarify the beta-lactam prescription or recommend an alternative antibiotic. Some PST programs also perform a post-test telephone call by a pharmacist to other healthcare professionals to reinforce the results of PST [41].…”

Section: Penicillin Allergy Documentationmentioning

confidence: 99%

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

et al. 2019

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Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST.

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“…Pharmacy-led counselling and provision of a wallet card detailing the results and implications of testing have been successfully used in some areas. 85 Whilst a consensus was not sought on this topic, the authors recommend that, as a minimum, written evidence of testing is provided to the patient and their primary care physician, and the electronic hospital record is updated accordingly. A wallet card that is standardised across geographical regions and becomes embedded in local practice might help prevent relabelling.…”

Section: Dissemination Of Results After Testingmentioning

confidence: 99%

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

Savic

Khan

Kopač

et al. 2019

British Journal of Anaesthesia

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Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.

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Effectiveness of Interventions to Maintain Penicillin Allergy Label Removal As Part of an Inpatient Penicillin Allergy Testing Protocol

Abstract: Abstracts AB183SUNDAY

Cited by 7 publications

References 0 publications

Antibiotic Allergy in Pediatrics

Antibiotic Allergy in Pediatrics

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations

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