The Role of History in Determining the Outcome of Penicillin Testing in Children

Abstract

Regional Health, Webster, NY. RATIONALE: Penicillin allergy is the most commonly reported antibiotic allergy. Avoidance of b-lactam antibiotics leads to use of second line therapies. Limited inpatient availability of allergy/immunology consultation may impede the use of penicillin skin testing (PST). We sought to evaluate the utility of telemedicine for inpatient penicillin allergy consultation. METHODS: An infectious disease PharmD identified adult inpatients with penicillin allergy receiving any antibiotics through an electronic medical record (EMR) report. Consented patients were administered a penicillin allergy history algorithm to determine appropriateness for PST, which was then performed by a physician assistant (PA). A telemedicine consult was performed by an allergy/immunology physician via Microsoft Lync. Patients were surveyed regarding their telemedicine experience. Negative PST patients were transitioned to a b-lactam antibiotic if indicated. RESULTS: A total of 338 patients were screened and 112 approached for study consent. Fifty patients consented to the study. Historical reactions to penicillin included rash (26%), hives (24%), angioedema (18%), unknown (12%), anaphylaxis (10%), itching (4%), shortness of breath (4%), and loss of consciousness (2%). Forty-six patients (92%) were PST negative. Thirty-three patients were transitioned to a b-lactam antibiotic. Patients rated their experience as an average of 4.5 (SD60.54) on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). The average physician time for telemedicine consultation was 4 minutes and 48 seconds (SD61:47). An estimated 45 minutes (SD65:31) per patient was saved in physician travel time. CONCLUSIONS: Telemedicine facilitates penicillin-allergy de-labeling, and carries high patient satisfaction scores. It is an efficient use of allergy/ immunology physician time and expertise.