Antibiotic allergy labels-the impact of taking a clinical history

Torda, Adrienne; Chan, Victor

doi:10.1111/ijcp.13058

Cited by 15 publications

(29 citation statements)

References 26 publications

(38 reference statements)

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“…We observed that the prevalence of 1 or more AALs for our aged care residents (24%) was high when compared with similar reports for Australian hospitalized patients (14%-24%). 4,5,[7][8][9] This finding may be related to the fact that the study cohort was aged and predominately female. Increasing age contributes to more AALs due to extensive antibiotic use over time and infrequent removal of AALs from health records.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Antibiotic allergy labels are frequently reported, with a prevalence estimated between 14.3% and 35.1%. [3][4][5][6][7][8][9] In a large study (411,543 outpatients), 15% of San Diego Kaiser Permanente health plan members reported at least 1 AAL. The most commonly reported AALs were penicillins (37,059 of 411,543, 9.0%,) and sulphonamides (22,321 of 411,543, 5.4%).…”

mentioning

confidence: 99%

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Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Travis

Worth

Trubiano

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:To determine the prevalence of antibiotic allergy labels (AALs) in Australian aged care residents and to describe the impact of labels on antibiotic prescribing practices.Design:Point-prevalence survey.Setting:Australian residential aged care facilities.Participants:We surveyed 1,489 residents in 407 aged care facilities.Methods:Standardized data were collected on a single day between June 1 and August 31, 2018, for residents prescribed an antibiotic. An AAL was reported if it was documented in the resident’s health record. Resident-level data were used to calculate overall prevalence, and antibiotic-level data were used to report relative frequency of AALs for individual antibiotics and classes.Results:Among 1,489 residents, 356 (24%) had 1 or more documented AALs. The AALs for penicillin (28.3%), amoxicillin or amoxicillin/clavulanic acid (10.5%), cefalexin (7.2%), and trimethoprim (7.0%) were most commonly reported. The presence of an AAL was associated with significantly less prescribing of penicillins (OR, 0.43; 95% CI, 0.31–0.62; P < .001) and significantly more prescribing of lincosamides (OR, 4.81; P < .001), macrolides (OR, 2.03; P = .007), and tetracyclines (OR, 1.54; P = .033). Of residents with AALs, 7 residents (1.9%) were prescribed an antibiotic that was listed on the allergy section of their health record.Conclusions:A high prevalence of AALs was observed among residents of Australian aged care facilities, comparable to the prevalence of AALs in high-risk hospitalized patients. Significant increases in prescribing of lincosamide, macrolide, and tetracycline agents poses a potential risk to aged populations, and future studies must evaluate the benefits of AAL delabelling programs tailored for aged care settings.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Travis

Worth

Trubiano

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Characterization of the reaction: Obtaining a thorough allergy history can provide information to help distinguish between a true allergy and non-allergic adverse reaction (NAAR). In a cross-sectional study of 426 hospitalized patients by Torda et al, 25.6% of patients described NAAR [29]. Comprehensive allergy histories are also crucial in determining the severity of a patient’s antibiotic allergies and potential risk/benefit of administering a similar class of antibiotic.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…By performing an allergy clarification, it may even be determined that a patient has never experienced symptoms of an allergy or NAAR. In the above-mentioned study, 7% of patients denied any allergy and claimed to tolerate the antibiotic [29].…”

Section: Review Of the Literaturementioning

confidence: 99%

Strategies for Clarifying Penicillin Allergies When Skin Testing Is Not an Option

et al. 2019

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Patients with reported penicillin allergies have been proven to experience negative health consequences, such as increased cost, suboptimal antimicrobial therapy, and adverse reactions. Though skin testing has been proposed as a method to clarify penicillin allergies, many institutions may lack the resources to perform skin testing on a wide scale. This literature review describes the current literature surrounding the use of penicillin allergy interviews when skin testing is not an option. Specifically, the review highlights the steps in carrying out a successful antibiotic allergy patient interview, summarizes the clinical evidence surrounding antibiotic allergy clarifications, and addresses key advantages and disadvantages of clarifying antibiotic allergies without the availability of skin testing.

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“…Although it is common for a patient or family member to declare a drug allergy, treating clinicians must verify the allergy by taking a thorough history and, if deemed necessary, test for a type 1 reaction. Often, obtaining a thorough history by interviewing the patient has proven effective in removing the purported allergy from the patient's medical profile [65,74].…”

Section: The Role Of Penicillin Allergy Testing In Antimicrobial Stewmentioning

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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Antibiotic allergy labels-the impact of taking a clinical history

Abstract: These simple measures to 'de-label' patients appropriately, would increase the quality of care of this group known to have higher costs, infection with more resistant bacteria and worse health outcomes that 'non-labelled' patients.

Cited by 15 publications

References 26 publications

Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Strategies for Clarifying Penicillin Allergies When Skin Testing Is Not an Option

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

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