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QI Project: De-labeling Low Risk Penicillin Allergies on the Inpatient Side
Abstract   Open access   Peer reviewed

QI Project: De-labeling Low Risk Penicillin Allergies on the Inpatient Side

Alick Feng, Andrew Simms, Abishek Pandya, Patrick Kinn, Amy Dowden, Deanna McDanel and Dilek Ince
Journal of allergy and clinical immunology, Vol.153(2_Suppl.), p.AB56
02/2024
DOI: 10.1016/j.jaci.2023.11.197
url
https://doi.org/10.1016/j.jaci.2023.11.197View
Published (Version of record) Open Access

Abstract

Rationale An erroneous penicillin allergy label (PAL) leads to less optimal and more expensive antibiotics while contributing to the rise of antimicrobial resistance. De-labeling programs can help achieve desired outcomes with minimal impact on resistance and healthcare costs. Methods Electronic Medical Record (EPIC) was used to identify hospitalized patients with PAL, prioritizing patients who were receiving antibiotics. Exclusion criteria included: anaphylaxis or angioedema to penicillin within the past 10 years, urticaria within the last 5 years, severe cutaneous adverse reactions (SCARS), acute interstitial nephritis, drug-induced liver injury secondary to penicillin, severe pulmonary conditions, solid organ transplant in last 30 days, critically ill patients, beta-blocker use and altered mental status. Appropriate patients were approached, consented when applicable, and proceeded with 1-step amoxicillin challenge (500 mg). Results In total, 68 patients were identified. Of the 68 identified, 37 patients were challenged with no adverse reactions (54%). Of the 31 that were not challenged, 9 had PAL removed for a history inconsistent with allergy, 8 reported severe reactions that were not in the chart, and 14 declined. Our approach was retrospectively compared to a validated penicillin allergy clinical decision tool [penicillin allergy, five or fewer years ago, anaphylaxis/angioedema or SCARS, and treatment required for an allergy episode (PEN-FAST)]. All challenged patients scored <2 points confirming the low-risk PALs selection. Conclusions Using a screening tool developed for hospitalized patients, our data supports the safety of inpatient de-labeling with single dose amoxicillin oral challenge. We are currently refining the exclusion criteria for the screening tool to expand eligibility.

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