Impact of β-Lactam Allergies on Antimicrobial Selection in an Outpatient Setting

Ness, Rachel A; Bennett, Jessica G; Elliott, Whitney V; Gillion, Amanda; Pattanaik, Debendra

doi:10.14423/smj.0000000000001037

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Other VA single-site studies have also reported an association between β-lactam allergy (mainly to penicillin-class antibiotics) and suboptimal antibiotic choices both in the outpatient and inpatient settings. [17][18][19] However, no consistent adverse signal on The presence of a penicillin allergy was not associated with differences in the rates of surgical site infections, though it was associated with antibiotic selection. Only smoking and vancomycin monotherapy were found to be independent predictors of SSIs.…”

Section: Prevalence and Impact Of Unverified Penicillin Allergy Label...mentioning

confidence: 98%

Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review

Kouma,

Guastadisegni,

Yang

et al. 2023

ASHE

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The presence of a penicillin allergy label in a patient’s medical chart is associated with negative clinical and economic outcomes. Given that less than 10% of reported reactions are truly immunoglobulin E-mediated, removal of unverified penicillin allergy labels is a public health priority and an area of ongoing implementation research. The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, with almost 9 million veterans currently enrolled. However, studies analyzing the impact of the penicillin allergy label in this population are limited to single facilities and largely focus on short-term outcomes of allergy documentation correction, usage of β-lactams, and avoidance of antibiotic-related side effects. Broader, national VHA studies focusing on health outcomes and costs are lacking. As with non-VHA facilities, penicillin allergy evaluations are limited owing to the absence of formal allergy/immunology services at most VHA facilities. Pharmacy-driven screening and referral for clinic-based penicillin skin testing is a promising and frequently discussed modality in the literature, but its scalability within the VHA is not yet proven. Broader, evidence-based strategies that can be adapted to the available resources of individual VHA facilities, including those without on-site access to allergy providers, are needed.

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Section: Prevalence and Impact Of Unverified Penicillin Allergy Label...mentioning

confidence: 98%

Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review

Kouma,

Guastadisegni,

Yang

et al. 2023

ASHE

View full text Add to dashboard Cite

show abstract

“…The Memphis Veterans Affairs Medical Center (MVAMC) in Tennessee recently examined the negative sequelae of β-lactam allergies and found that more than half the patients received inappropriate antibiotics based on guideline recommendations, allergy history, and culture and sensitivity data. 12 To mitigate the problems for patients with β-lactam allergies, the 2016 guidelines from the Infectious Diseases Society of America (IDSA) on the Implementation of Antimicrobial Stewardship Programs (ASP) recommend that these patients undergo allergy assessment and penicillin skin testing. 13 In November 2017, MVAMC implemented such a process.…”

mentioning

confidence: 99%

Implementation and Impact of a β -Lactam Allergy Assessment Protocol in a Veteran Population

Mitchell¹

2021

Federal Practitioner

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Background: Approximately 10% of the US population reports having a β-lactam allergy, although nearly 90% do not have a true immunoglobulin E (IgE)-mediated reaction. This misconception results in using nonpreferred antibiotics, leading to antimicrobial resistance and treatment failure. To evaluate, clarify, and clear β-lactam allergies, we implemented a pharmacistdriven β-lactam allergy assessment (BLAA) protocol and penicillin allergy clinic (PAC). The purpose of this study was to illustrate the BLAA process, including the pharmacist-run PAC, and assess the impact on allergy clearance. Methods: Clinical pharmacy specialists (CPS) evaluated hospitalized veterans with β-lactam allergies, using the BLAA protocol. Eligible patients could later be seen in PAC. This was a retrospective observational review of the BLAA protocol to assess recommendations for β-lactam antibiotic use and PAC outcomes.Results: Between November 2017 and February 2020, 278 patients were evaluated, and 32 were seen in the clinic. The most common allergen was penicillin, and the most reported reaction was a rash (27%) or pruritus and urticaria (18%). Through PAC and the BLAA protocol, 86 patients (31%) were cleared for allergy removal, and 188 (68%) were cleared for alternative β-lactams. The evaluation revealed that 274 patients (99%) were eligible to receive a β-lactam antibiotic, and only 4 patients (1%) were recommended for avoidance of all β-lactams. Conclusions: These findings highlight the utility of the pharmacist-driven BLAA protocol. We illustrated that most patients with documented β-lactam allergies were eligible for alternative β-lactams. The implementation of the BLAA protocol and pharmacist-run PAC facilitated allergy clearance and has the potential to promote alternative β-lactam use.

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Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies

Gray

Dhavalikar

Boyce

et al. 2023

Journal of Hospital Infection

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Impact of β-Lactam Allergies on Antimicrobial Selection in an Outpatient Setting

Cited by 3 publications

References 27 publications

Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review

Challenges and opportunities related to penicillin allergy in the Veterans Health Administration: a narrative review

Implementation and Impact of a β -Lactam Allergy Assessment Protocol in a Veteran Population

Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies

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