This is a short follow-up study that touches upon a ubiquitous subject of which we’re mostly familiar – most patients with a stated allergy to penicillin do not actually have a true, IgE-mediated reaction. In the original study, these authors performed a standard 3-tier allergy testing on 100 patients with “low-risk” reported allergy symptoms, all of whom tested negative and ultimately passed a 500mg amoxicillin challenge dose. Now, in this study, these authors re-contacted the patients and the primary care physicians to determine the downstream communication, effects of the allergy testing notification, and any adverse events related to prescribing after removal of the allergy from the patient’s chart.
Without going into much detail, there was a huge disconnect – most parents reported relaying the information, most physicians reported no information was relayed, and about half the patients had the allergy still listed in their chart. Regardless, 26 patients filled at least one prescription for a pencillin-derivative medication within the year, and one child developed a rash attributed to the amoxicillin.
The authors use this narrow experience to estimate cost savings attributed to using penicillin derivatives versus cephalosporins or clindamycin, and determine their allergy testing resulted in $1,368.13 in savings. Across the 6,700 reported penicillin allergies annually in their ED, they estimate accurate allergy information and delabeling could save nearly $200k each year.
This hardly represents all the benefits of delabeling, as the antibiotics avoided are also typically broader-spectrum, with greater contributions to antibiotic resistance. Clearly, a simpler, accepted pathway to expedite penicillin allergy delabeling would be of great value.
“Antibiotic Use After Removal of Penicillin Allergy Label”
http://pediatrics.aappublications.org/content/early/2018/04/18/peds.2017-3466