The Cost of Self-Reported Penicillin Allergy: A Systematic Review

Mattingly, T. Joseph; Fulton, Anne B.; Lumish, Rachel A.; Williams, Anne; Yoon, SeJeong; Yuen, Melissa; Heil, Emily L.

doi:10.1016/j.jaip.2017.12.033

Cited by 111 publications

(89 citation statements)

References 33 publications

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“…It has been considered that a correct diagnosis could save around 1145-4254$ per patient. 20,21 Over recent years, mislabelling is showing to be a relevant problem in two ways: (a) false label of allergic, which increment the real DHR incidence and affect the individual treatment options; (b) false In this review, we have considered these problems highlighting the recent advances about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management.…”

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…Inappropriate allergy labels result in increased healthcare costs and adverse events. 16,17 Our results show that more than 85% of penicillin allergy labels in our patient group were incorrect. This finding is consistent with those of other reports 2,5 and supports the need for allergy evaluation services in our healthcare system.…”

Section: Discussionmentioning

confidence: 69%

β‐Lactam allergy testing and delabeling—Experiences and lessons from Singapore

Heng

Liew

Kong

et al. 2020

Immunity Inflam & Disease

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Background: β-Lactam allergy is over-reported and this leads to greater healthcare costs. Allergy testing has inherent risks, yet patients who test negative may continue avoiding β-lactams. Objective: To evaluate the safety and diagnostic value of β-lactams allergy testing locally and usage of antibiotics following negative testing. Methods: We performed a retrospective medical record review and follow-up survey of patients who underwent β-lactam testing between 2010 and 2016 at the National Skin Centre, Singapore. Results: We reviewed the records of 166 patients, with a total of 173 β-lactam allergy labels. Eighty (46.2%) labels were to penicillin, 75 (43.1%) to amoxicillin/amoxicillin-clavulanic acid, 11 (6.4%) to cephalexin, and 5 (2.9%) to others. Skin tests were performed in 142 patients and drug provocation tests (DPTs) in 141 patients. Eleven (6.6%) patients defaulted DPTs after skin testing. Out of 166 patients, 22 (13.3%) patients were proven allergic by either skin tests (16) or DPTs (6). Patients who tested positive had nonsevere reactions. Out of 155 patients who were conclusively evaluated, 133 (85.8%) were not allergic. Of these patients, 30 (22.6%) used the tested β-lactam subsequently, with one reporting a mild reaction. Fifty-one (38.3%) patients were uncontactable or uncertain if they consumed a β-lactam since testing negative. Fifty-two (39.1%) patients had no re-exposure (35 had no indication, 17 were fearful of reactions). Conclusion: Drug allergy testing was safe and removed inappropriate labels. Clinical Implication: Allergy testing is efficacious, but fears of subsequent rechallenge should be addressed to maximize the effectiveness of allergy delabeling.

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“…In a retrospective study at a Veterans Affairs hospital, patients with a penicillin allergy had a significantly longer time to receipt of first antibiotic dose (236 minutes vs 187 minutes, P = .03), and were more likely to receive a carbapenem or fluoroquinolone antibiotic (P < .00001), which may have implications on selection of more antimicrobial resistance or C. difficile infections [23]. From an economic standpoint, a recent comprehensive meta-analysis showed that reported penicillin-allergic patients had higher outpatient and inpatient drug costs and inpatient hospitalizations that cost on average $1145-$4254 more per patient [24].…”

Section: Adverse Outcomes In Patients Allergic To Penicillinmentioning

confidence: 99%

Is a Reported Penicillin Allergy Sufficient Grounds to Forgo the Multidimensional Antimicrobial Benefits of β-Lactam Antibiotics?

Sakoulas

Geriak

Nizet

2018

Clinical Infectious Diseases

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The majority of patients with reported penicillin allergy are not allergic when tested or challenged. Penicillin allergy testing has been shown to significantly reduce future annual healthcare expenditures. Data have emerged showing beta-lactams to be multi-dimensional antibacterial effects in vivo, far beyond what is appreciated in standard bacteriological susceptibility testing media. These include enhancing bacterial killing by the innate immune system. Supporting the clinical relevance of these secondary underappreciated effects are recent clinical and pharmaco-economic analyses that show worse outcomes in patients with reported penicillin allergies who receive non-beta lactam antibiotics when compared to their non-penicillin allergic counterparts. This is particularly relevant in the treatment of Staphylococcus aureus bacteremia.This article reviews the tremendous advantages offered by beta-lactam therapy and makes a strong case that the debunking of false penicillin allergies through a detailed allergy history and penicillin allergy testing should be a vital component of antimicrobial stewardship practices.

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The Cost of Self-Reported Penicillin Allergy: A Systematic Review

Abstract: Evaluations of clinical and economic outcomes of PCN allergy are primarily observational and focus on inpatient populations. Long-term relationships between PCN allergy and clinical and economic outcomes are unknown.

Cited by 111 publications

References 33 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

β‐Lactam allergy testing and delabeling—Experiences and lessons from Singapore

Is a Reported Penicillin Allergy Sufficient Grounds to Forgo the Multidimensional Antimicrobial Benefits of β-Lactam Antibiotics?

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