The Value of Skin Testing for Penicillin Allergy in an Inpatient Population: Analysis of the Subsequent Patient Management

Abstract

It was decided to assess the value of skin testing in a group of inpatients with a remote history of penicillin allergy, in terms of whether or not beta-lactams were subsequently given, if any adverse reactions occurred as a result of this therapy, and if labeling of the patient record was changed subsequent to skin testing and/or challenge. All patients seen in consultation with a history of penicillin allergy were assessed. When done, skin tests were performed with the major and minor determinants of penicillin and semisynthetic penicillins. Charts were reviewed after discharge in terms of the antibiotics given during admission, adverse events, and the medical record and hospital database labeling for drug allergy at discharge. Skin testing was carried out in 79% of 67 patients assessed and in all, the tests were negative. Beta-lactam therapy was recommended in 51/53 patients but was given in only 57% of these cases. At discharge, 49% of patients' records still carried the penicillin allergy label, despite negative skin testing and/or successful completion of a course of beta-lactam therapy. So, in approximately half of the patients reviewed, beta-lactams were not given despite negative skin tests and a recommendation to do so, if indicated, and 49% of patients were still inappropriately labeled as being penicillin-allergic on discharge.

Assessment of the current practice of antibiotic skin testing in a tertiary Hospital in United Arab Emirates

“…In our study we found poor documentation of the results. Similar findings were reported by Warrington et al [22] in a study in which 49% of patients were still labeled as penicillin allergic despite having negative skin tests or an uneventful drug challenge. Poor documentation could be expected to be associated with discrepancies between the medical record and the allergy history [7].…”

Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta‐analysis

“…The negative predictive value of inpatient allergy testing is comparable to outpatient and perioperative cohort data . Furthermore, the intervention has consistently shown to reduce the use of broad‐spectrum antibiotics, a finding that has been reported from studies in the perioperative setting . Antibiotic prescription changes in the inpatient setting may have greater implications than in the perioperative setting.…”

“…19,47 Furthermore, the intervention has consistently shown to reduce the use of broadspectrum antibiotics, a finding that has been reported from studies in the perioperative setting. 48 Antibiotic prescription changes in the inpatient setting may have greater implications than in the perioperative setting. Most inpatients receive antibiotics with therapeutic intent rather than prophylaxis with longer treatment duration.…”

Penicillin allergy label persists despite negative testing

“…Alternative antibiotics were still chosen for 43% of patients for whom beta-lactam therapy was recommended, and 50% of patients were mislabeled with penicillin allergy at discharge. 4 Prematta et al surveyed primary care physicians (internal medicine, pediatrics, family medicine, and internal medicine-pediatrics trained providers were included), and they found that there was great confusion regarding penicillin testing and the cross-reactivity and safety of utilizing other beta-lactams in the patient with penicillin allergy. 5 With the increase in the use of electronic medical records, one would assume that penicillin allergy labels would be more likely to be removed after documented tolerance or negative testing, but Rimawi et al found otherwise.…”