Skin Testing Plus APP May Reduce Overdiagnosis of Penicillin Allergy

MedicalResearch.com Interview with:
Kimberly Gold Blumenthal, M.D
Assistant Professor of Medicine
Massachusetts General Hospital

MedicalResearch.com: What is the background for this study?

Response: Over-reported penicillin allergies negatively impact patient care, as alternative drugs that are often used can be less effective, more toxic, more broad-spectrum (killing all of the good bacteria and leaving patients increasingly vulnerable to C.diff colitis), and more expensive. Most hospitalized patients who have a recorded penicillin allergy are not actually allergic. This has drawn attention by national organizations such as the CDC, National Quality Forum, and both allergy and infectious diseases professional societies. The message is clear: Address reported penicillin allergies in some way to improve care.

MedicalResearch.com: What are the main findings?

Response: In a study conducted at Brigham and Women’s Hospital on the internal medicine services, we evaluated outcomes associated with two sequential approaches for inpatients with penicillin allergy on their record and an infection:

(1) penicillin skin testing all possible patients reporting penicillin allergy with the FDA-approved penicillin skin test and

(2) using a computerized guideline/app to help clinicians re-challenge drugs safely and call for a penicillin skin test when needed.

We found that the app safely increased the use of penicillins and cephalosporins almost 2-fold compared to the standard of care period. Specifically, the adjusted odds ratio – when adjusting for patient differences across periods—was 1.8 [95%CI 1.1, 2.9]. While skin testing overall as an inpatient policy did not have a significant impact, patients who were tested had a 6-fold increased odds of receiving a penicillin or cephalosporin, which demonstrates the large impact skin testing hospitalized patients can have. All of the 43 patients we skin tested were found not-allergic, and so these patients are eligible for penicillins and cephalosporins for any future infection (outpatient and inpatient). While many patients in the app period also had their allergy removed, but some patients only have their allergy amended to include that they tolerated a certain penicillin-related drug.

MedicalResearch.com: What should readers take away from your report?

Response: The findings are important because 10-15% of hospitalized patients have a penicillin allergy on their medical record, but >95% of them are not allergic. These over-reported penicillin allergies negatively impact patient care, as alternative drugs that are often used are less effective, more toxic, and more broad-spectrum, leaving patients increasingly vulnerable to C.diff colitis and our community with growing antibiotic resistance. The message is clear: Address reported penicillin allergies in some way to improve care. However, how this should be done remains unclear. Currently, only about 10% of all hospitals are even equipped to perform the penicillin skin test and most hospitals do not have access to allergy specialists. The app was notably used by non-allergist providers. This research conveys that improvements can be made with skin testing and guidelines.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our next steps for hospitalized patients must consider the impact achieved with designated skin testers and an app that is integrated into the electronic medical record. After that, we must look at multi-site research of inpatients as well as other populations, such as outpatients, surgical patients, and others and identify how best to address inaccurate penicillin allergies at the population level.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Kimberly G. Blumenthal, Paige G. Wickner, Shelley Hurwitz, Nicholas Pricco, Alexandra E. Nee, Karl Laskowski, Erica S. Shenoy, Rochelle P. Walensky. Tackling Inpatient Penicillin Allergies: Tools for Antimicrobial Stewardship. Journal of Allergy and Clinical Immunology, 2017; DOI: 10.1016/j.jaci.2017.02.005

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 15, 2017 by Marie Benz MD FAAD