Penicillin Allergy…Maybe Not? The Military Relevance for Penicillin Testing and De-labeling

Abstract

A penicillin allergy label is a risk to military readiness secondary to associated increases in the length of hospitalizations and emergency department and medical visits. Penicillin de-labeling is a simple intervention that can improve readiness, significantly decrease health care costs and prevent antibiotic resistance, as well as antibiotic-associated adverse events. The military allergist should be "front and center" providing expertise guidance and leadership for clinic and hospital-based penicillin de-labeling efforts which are nested within the antibiotic stewardship programs.

Penicillin Allergy Delabeling Can Decrease Antibiotic Resistance, Reduce Costs, and Optimize Patient Outcomes

“…24 When these potential savings are applied to the military insurance population of 9.4 million beneficiaries (TRICARE, including active duty, their dependents, and all retirees participating in the program), the results showed that this could impart a savings of nearly $1.7 billion annually, using the model by Macy and Contreras. 23,25,26 Previously with colleagues, I reviewed penicillin's role in military history, compiled data from relevant studies from military penicillin allergy rates and delabeling efforts, and calculated the potential economic impact of penicillin allergies along with the benefits of testing. 26 Calculations were estimated using the TRICARE beneficiary population (9.4 million) × the estimated prevalence (10%) to get an estimate of 940,000 TRICARE patients with penicillin allergy in their medical record.…”

“…23,25,26 Previously with colleagues, I reviewed penicillin's role in military history, compiled data from relevant studies from military penicillin allergy rates and delabeling efforts, and calculated the potential economic impact of penicillin allergies along with the benefits of testing. 26 Calculations were estimated using the TRICARE beneficiary population (9.4 million) × the estimated prevalence (10%) to get an estimate of 940,000 TRICARE patients with penicillin allergy in their medical record. 25 If 90% of those patients were delabeled, this would equal 846,000 TRICARE patients.…”

“…When multiplied by the potential savings of $2,000 per patient per year, the estimated savings would be $1,692,000,000 annually. 23,26 Current literature provides compelling evidence that all health care plans should use penicillin allergy testing and delabeling programs. 3,23,26 As most patients with a history of penicillin allergy in their medical records do not have a verified allergy, delabeling those who do not have a true allergy will have individual, public health, and cost benefits.…”

“…23,26 Current literature provides compelling evidence that all health care plans should use penicillin allergy testing and delabeling programs. 3,23,26 As most patients with a history of penicillin allergy in their medical records do not have a verified allergy, delabeling those who do not have a true allergy will have individual, public health, and cost benefits. 3,7,23,26 ANTIBIOTIC STEWARDSHIP Antibiotic stewardship programs are now mandated to combat antibiotic resistance.…”

“…3,23,26 As most patients with a history of penicillin allergy in their medical records do not have a verified allergy, delabeling those who do not have a true allergy will have individual, public health, and cost benefits. 3,7,23,26 ANTIBIOTIC STEWARDSHIP Antibiotic stewardship programs are now mandated to combat antibiotic resistance. 3,27 This program is supported by major medical organizations, including the Centers for Disease Control and Prevention, Society for Healthcare Epidemiology of America, Infectious Disease Society of America, and the American Academy of Allergy Asthma and Immunology.…”