Penicillin Allergy Skin Testing in the Inpatient Setting

Justo, Julie Ann; Kufel, Wesley D; Avery, Lisa M.; Bookstaver, P. Brandon

doi:10.3390/pharmacy7030120

Cited by 11 publications

(10 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A c c e p t e d D r a f t evaluating cross-reactivity potential among beta-lactam antibiotics, and providing other types of allergy evaluations or challenges. [20][21][22][23][24][25] Pharmacist opportunities and involvement in PAAST are also expanding to outpatient settings. 26 Given the significant impact pharmacists can have in PAAST, appropriate education is essential.…”

Section: A J P Ementioning

confidence: 99%

Instruction and Simulation to Improve Pharmacy Students’ Knowledge and Confidence Regarding Assessment of Penicillin Allergies

Kufel

Blaine

Ruehl

et al. 2022

American Journal of Pharmaceutical Education

Self Cite

View full text Add to dashboard Cite

Objective. To evaluate pharmacy students' knowledge and confidence regarding penicillin allergy assessment and skin testing (PAAST) before and after a focused didactic instruction and simulation (FDIS). Methods. A multicenter, quasi-experimental, cross-sectional survey study was performed among pharmacy students before and after FDIS on PAAST at two schools of pharmacy. The FDIS on PAAST consisted of an infectious disease faculty-led seminar, student-led penicillin allergy counseling interviews, penicillin skin testing simulation, and case studies to assess penicillin allergy scenarios and management. An anonymous, voluntary, electronic survey was distributed to students (n=159) before and after the FDIS. The pre-and post-intervention survey contained ten PAAST knowledge-based questions and multi-step, 5-point Likert scale statements related to confidence of PAAST. The postintervention survey also evaluated students' perceptions of the FDIS on PAAST. Descriptive statistics were performed, and the Student t-test was used to compare pre-and post-intervention responses. Results. One-hundred and forty-three surveys were completed resulting in a survey response rate of 90%. PAAST knowledge scores (mean±SD) increased overall following the FDIS on PAAST (6.67±1.51 vs. 7.81±1.39). Knowledge scores increased considerably for questions related to penicillin allergy consequences, cross-reactivity, and correct steps of PAAST. Pharmacy students' PAAST confidence scores (mean±SD) also improved following the interactive instruction and simulation (2.30±0.70 vs. 3.22±0.67) with considerable confidence increases in penicillin skin testing. Pharmacy students' perceptions of the FDIS on PAAST were also positive overall. Conclusion. Pharmacy students' knowledge and confidence of PAAST improved following FDIS. This may be an effective strategy to implement PAAST education during pharmacy school.

show abstract

Section: A J P Ementioning

confidence: 99%

Instruction and Simulation to Improve Pharmacy Students’ Knowledge and Confidence Regarding Assessment of Penicillin Allergies

Kufel

Blaine

Ruehl

et al. 2022

American Journal of Pharmaceutical Education

Self Cite

View full text Add to dashboard Cite

show abstract

“…The focus is on areas where pharmacists can improve the care of a patient labeled with a penicillin allergy. A detailed review of penicillin allergy assessment and PST in the inpatient setting, including the PST process, is described elsewhere [13].…”

Section: Introductionmentioning

confidence: 99%

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

et al. 2019

Self Cite

View full text Add to dashboard Cite

Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST.

show abstract

“… 53 Both DCTs and PST are a favourable option that excludes IgE-mediated reactions with a more than 95% NPV. 54 If such tests are negative, it is unlikely that a patient is allergic to penicillin. 36 Conversely, desensitization should be considered if a drug is required in patients with proven or highly likely allergy and no alternative treatment is available as may be the case in severe infections.…”

Section: Penicillin Skin Testing (Pst)mentioning

confidence: 99%

Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs

Mabilat

Gros

Belkum

et al. 2022

JAC-Antimicrobial Resistance

View full text Add to dashboard Cite

Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although up to 10% of all patients may report penicillin allergy, most penicillin allergies are not confirmed. As such, most patients with a penicillin allergy can still safely use penicillin and related drugs following a more precise assessment. Herein, we review the current practices and unmet needs in penicillin allergy testing. The diagnostic algorithm is mostly based on a clinical history assessment followed by in vivo testing, i.e. skin test and/or drug challenge. As these tests are labour and resource intensive, there is increased interest in point-of-care penicillin allergy de-labelling solutions incorporated into Antimicrobial Stewardship Programmes including digital assessment tools. These can be locally parameterized on the basis of characteristics of target populations, incidence of specific allergies and local antibiotic usage to perform clinical risk stratification. Safely ruling out any residual risk remains essential and in vivo drug challenge and/or skin testing should be systematically encouraged. Gradual understanding and convergence of the risk stratification of the clinical presentation of penicillin allergy is enabling a wider implementation of this essential aspect of antimicrobial stewardship through digitalized decision tools and in vivo testing. More research is needed to deliver point of care in vitro diagnostic tools to democratize this de-labelling practice, which would be highly beneficial to patient care. This progress, together with better education of patients and clinicians about the availability, efficacy and safety of penicillin allergy testing, will increase the dissemination of penicillin allergy assessment as an important component of Antimicrobial Stewardship Programmes.

show abstract

Penicillin Allergy Skin Testing in the Inpatient Setting

Cited by 11 publications

References 30 publications

Instruction and Simulation to Improve Pharmacy Students’ Knowledge and Confidence Regarding Assessment of Penicillin Allergies

Instruction and Simulation to Improve Pharmacy Students’ Knowledge and Confidence Regarding Assessment of Penicillin Allergies

Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs

Contact Info

Product

Resources

About