Expedited Clearance of Beta-Lactam Allergies at Rady Children's Hospital

Abstract

A 2016 AAAAI position statement recommended routine evaluation of beta-lactam allergies due to the burden of pervasive mislabeled allergies. This quality improvement study implemented strategies to expedite evaluation at Rady Children's Hospital. METHODS: A real-time list of inpatients with beta-lactam allergies, Best Practice Advisory and automatic referral was created in EPIC. Pharmacy staff documented reactions using a standardized Smartform aimed at distinguishing reaction types (i.e., immediate vs delayed). The Smartform was also used to document reactions of outpatients in Allergy Clinic. Skin testing was performed for first-day reactions, a raised and mobile rash, or by family request. Children with negative skin testing or with non-severe delayed reactions were given graded challenges. RESULTS: 118 patients (15 months to 24 years) were interviewed over 4 months. 34 were evaluated in clinic. 11 (32%) had skin testing. 2 skin tests were positive, and 3 skin tests were incomplete due to discomfort; however, the part performed was negative and the patients passed challenges. The time interval between reaction and testing ranged from 1 month to 14 years. There were no adverse reactions, including during the week following challenge. 32 (94%) of patients evaluated in clinic, and 100% of those offered the challenge, passed. Of 84 admitted patients, 36 (43%) had history that qualified them for skin testing (43%). CONCLUSIONS: This project adapted EPIC tools to expedite evaluation of beta-lactam allergies. Our results suggest that skin testing may not be necessary for the majority of children labeled with a beta-lactam allergy.