An estimated 10% of the US population reports having an allergic reaction to a penicillin-class antibiotic. However, when evaluated, fewer than 1% are truly allergic. Broad-spectrum antibiotics are a common alternative to penicillins and are associated with more side effects, higher healthcare costs, and antimicrobial resistance. When a patient’s allergy is removed from their medical record after a medical evaluation, it is called de-labeling. De-labeling patients who are not truly allergic to penicillins is an important stewardship tool that decreases unnecessary use of broad-spectrum antibiotics.
As a part of their work with the University of North Carolina at Chapel Hill’s Institute for Healthcare Quality Improvement (IHQI), Renae Boerneke, PharmD, BCPS, CPP, and Mildred Kwan, MD, PhD, created a penicillin allergy assessment tool kit to educate patients and their caregivers and to train healthcare providers on how to proactively assess penicillin allergies. For patients, they developed a fact sheet on why allergy assessment matters. They also developed step-by-step training materials for providers ready to provide assessments for their patients using an Epic SmartPhrase. (Provider resources require a UNC Health log-in.)
In a related pilot in December 2020, Ashlyn Norris, PharmD, delabeled nearly one in four (24%) of patients assessed in the UNC Medical Center Emergency Department. Boerneke, Kwan, and Norris agree that penicillin allergy assessments are good for patients and fighting antibiotic resistance alike.
The Penicillin Allergy Assessment Tool Kit is a collaboration of the UNC Medical Center’s Carolina Antimicrobial Stewardship Program, the UNC Division of Rheumatology, Allergy & Immunology, and IHQI. Access the tool kit: https://www.med.unc.edu/casp/educational-resources/.