A Better Way to Evaluate Penicillin Allergies

On September 28, 1928, Alexander Fleming discovered penicillin. To commemorate this momentous discovery, every year on September 28^th, we celebrate National Penicillin Allergy Day to raise awareness that carrying a penicillin allergy label may negatively affect a patient’s health when it is not accurate.

Even though 10% of the U.S. population believes they have a penicillin allergy, less than 1% of the population is truly allergic. For the 9 out of 10 patients that are no longer (or never were) allergic, the allergy “label” on their medical record can lead to a host of negative consequences. They are often prescribed alternative antibiotics that are more expensive than penicillin, putting them at greater risk for developing multi-drug resistant infections.

Additionally, patients with a penicillin allergy have more frequent and longer hospitalizations compared to non-allergic patients. Evaluating patients’ penicillin allergies for penicillin tolerance can alleviate burdens associated with a true allergy.

Allergists play a significant role in allergy evaluation at an estimated cost of $40 for some insured patients up to $700 for an uninsured patient paying out of pocket. But Renae Boerneke, PharmD, BCPS, CPP a clinical pharmacist practitioner, and Mildred Kwan, MD, PHD, an assistant professor of medicine in the Division of Rheumatology, Allergy, and Immunology, found a way to make allergy evaluation more accessible. They developed a process to conduct allergy assessments using an Epic dot phrase and risk stratification chart.

Instead of requiring the expertise of any allergist in all cases, the evaluation can be carried out by a pharmacist or provider with the step-by-step tools. Based on screening questions, the patient may require an additional visit with an allergist. However, Boerneke found that pharmacists or non-allergist providers were able to de-label one in four patients screened, with no additional allergist visit needed. The change saved time and money for these patients, compared to evaluation using an allergist alone.