{"id":14127,"date":"2022-09-28T13:33:35","date_gmt":"2022-09-28T17:33:35","guid":{"rendered":"https:\/\/www.med.unc.edu\/tarc\/?p=14127"},"modified":"2022-09-28T14:04:17","modified_gmt":"2022-09-28T18:04:17","slug":"dr-millie-kwan-and-dr-renae-boerneke-help-spread-the-word-regarding-a-better-way-to-evaluate-penicillin-allergy","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/tarc\/dr-millie-kwan-and-dr-renae-boerneke-help-spread-the-word-regarding-a-better-way-to-evaluate-penicillin-allergy\/","title":{"rendered":"Dr. Millie Kwan and Dr. Renae Boerneke Help Spread the Word Regarding a Better Way to Evaluate Penicillin Allergy"},"content":{"rendered":"<h3><em>Twenty four percent <\/em><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2863 size-full alignleft\" style=\"font-size: 14px\" src=\"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2020\/10\/Kwan-Boerneke.jpeg\" alt=\"headshots of Kwan and Boerneke\" width=\"286\" height=\"248\" \/><em style=\"color: inherit\"> of patients reporting a penicillin allergy had their allergy label removed after a five-minute pharmacy screening.<\/em><\/h3>\n<p>&nbsp;<\/p>\n<p>On September 28, 1928, Alexander Fleming discovered penicillin. To commemorate this momentous discovery, every year on September 28<sup>th<\/sup>, we celebrate National Penicillin Allergy day to raise awareness that carrying a penicillin allergy label may negatively affect a patient\u2019s health when it is not accurate.<\/p>\n<p>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 \u201clabel\u201d 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\u2019 penicillin allergies for penicillin tolerance can alleviate burdens associated with a true allergy.<\/p>\n<p>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 Dr. Renae Boerneke, clinical pharmacist practitioner, and Dr. Mildred Kwan, allergist, 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 an 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.<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-4141 size-large\" src=\"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2022\/09\/2-1-e1664308872405-1024x686.png\" alt=\"shows graphically results of pen allergy assessments described in narrative\" width=\"1024\" height=\"686\" \/><\/p>\n<p>Over the last several years, 164 patients at the UNC Infectious Diseases Clinic participated in penicillin allergy assessments, resulting removal of penicillin allergy in 43% (71\/164) of patients assessed. Nearly 24% (39) required only a brief pharmacist assessment for their allergy label to be removed. \u201cA small number\u2013five patients\u2013had true allergies to penicillin confirmed during the assessment, so there was no change to their medical records,\u201d Boerneke said.<\/p>\n<p>The remaining patients required further evaluation by an allergist. A pharmacist made a referral for those interested in continuing at their own expense. Patients also had to be classified as low-risk (and therefore able to be evaluated using an oral amoxicillin graded challenge) or moderate-to-high-risk (assessed with a penicillin skin test followed by oral challenge) according to the screening questions. Of the patients who completed a second assessment with an allergist, 82% (32) were de-labeled, and the remaining 18% (7) had their allergy confirmed.<\/p>\n<p>A meaningful proportion of de-labeled patients (43%) went on to receive a penicillin-class antibiotic, and only one patient (1%) experienced a mild delayed-onset rash to amoxicillin-clavulanic acid after previously passing the oral amoxicillin challenge. No other significant adverse events after penicillin use were documented.<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-3117\" src=\"https:\/\/www.med.unc.edu\/casp\/wp-content\/uploads\/sites\/563\/2021\/03\/Penicillin-Allergy-Icon-updated-246x300.png\" alt=\"graphic of a tool kit with words penicillin allergy assessment tool kit\" width=\"180\" height=\"219\" \/><\/p>\n<p>A penicillin allergy assessment<a href=\"https:\/\/www.med.unc.edu\/casp\/educational-resources\/penicillin-allergy-assessment-tool-kit\/\">\u00a0tool kit<\/a>\u00a0is available to help train non-allergy providers to incorporate this important practice into their patient care. In under five minutes, a simple assessment can lead to improvements in patients\u2019 health and healthcare expenditures, while potentially slowing the spread of antibiotic resistance.<\/p>\n<p>Those interested in learning more may contact Renae.Boerneke@unchealth.unc.edu and Mildred.Kwan@med.unc.edu.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Twenty four percent of patients who were reporting a penicillin allergy had their allergy label removed after a 5-minute pharmacy screening. <\/p>\n","protected":false},"author":58060,"featured_media":14129,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[2],"tags":[],"class_list":["post-14127","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","odd"],"acf":[],"yoast_head":"<!-- This site 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