According to the American Academy of Allergy, Asthma & Immunology, about 10 percent of the population, or almost 33 million people, are labeled as being allergic to penicillin. This is because symptoms like a rash, an upset stomach, vomiting, diarrhea, and hives corresponding with penicillin use are often misinterpreted as proof of an allergy to the medicine. But even in those with a true penicillin allergy, 80 percent will grow out of it over the course of 10 years. That means about 29.5 million people are mislabeled and this may unnecessarily limit the patient’s treatment options..
“There are a lot of misgivings and misunderstandings,” said Shafinaz Akhter, MD, director of Antimicrobial Stewardship at Chester County Hospital. “I’ve had plenty of people tell me that a penicillin allergy runs in their family” even though there’s no evidence that it’s hereditary.
Over the last year or so, Akhter had been working with the Infectious Disease team to develop a protocol that uses penicillin skin testing (PST) to identify patients who truly have an allergy to penicillin. However, this past March, they had to put the program on hold to focus their efforts on preparing and caring for COVID-19 positive patients. Now that the hospital is starting to implement more elective procedures, the penicillin allergy testing protocol is beginning to get new life.
As part of the PST protocol, a clinician identifies patients who would benefit from PST based upon allergy history. Then, once the test is completed, the results are placed in the patient’s chart, the attending physician is notified, and a letter is sent to the patient’s primary care provider and primary outpatient pharmacy. The documented penicillin allergy is removed and replaced by either “Penicillin Skin Test Negative,” or “Penicillin Skin Test Positive.”
Since its inception, over 100 patients have received PST, all with a negative result and that has shown an impact on patient outcomes. Patients who received PST — versus those treated with aztreonam (an antibiotic commonly used if a patient has a penicillin allergy) for more than 24 hours — experienced fewer admissions.
“The reduction in readmissions demonstrates that removing or clarifying a penicillin allergy benefits the patient not only for the acute episode, but also for the rest of their lives when antimicrobials may be prescribed,” Akhter said.
The team received the “I Am Patient Safety” award from the Patient Safety Authority for their testing protocol. The team also received an honorable mention in the Penn Medicine Quality & Patient Safety Awards for their work to improve patient care.
As the hospital continues to incorporate elective programs and procedures that were initially delayed due to the COVID-19 outbreak, Akhter and her team look forward to incorporating the testing on a more regular basis.