ASSESSING THE PERSISTENCE OF PENICILLIN ALLERGY LABELS POST ALLERGY EVALUATION

Abstract

Introduction Penicillin skin testing (ST) followed by an oral challenge remains the standard of care to remove the label of penicillin allergy. Despite a negative penicillin allergy evaluation, studies have shown persistence/re-documentation of penicillin allergy upon further follow-up. Methods Inpatients and outpatients evaluated for penicillin allergy from 2012 to 2017 were identified from a retrospective chart review. Patients with a negative allergy evaluation (testing plus challenge) were contacted via phone to complete a follow-up survey regarding their awareness of results and whether they had any subsequent courses of penicillin/penicillin derivatives. Additionally, electronic charts were reviewed and the patient's pharmacy was contacted to assess if the penicillin allergy label remained. Results A total of 33 patients with a negative ST tolerated an oral challenge and were “de-labeled” of their penicillin allergy. Follow up was done with 24 de-labeled patients, and 96% (n=23) recalled the results of their testing accurately. Nine patients were unavailable for follow up. Nine patients reported tolerating subsequent courses of penicillin since their allergy evaluation; however 3 patients were still fearful of a possible reaction and continued to avoid penicillin. The penicillin allergy label was appropriately removed from the EMR in 66.6%(n=22) of patients, and from pharmacy records in 78.7%(n=26) of patients. Conclusions Our study revealed that while penicillin allergy evaluation is safe and effective, there are barriers to removing the penicillin allergy label in clinical practice including patient apprehension and removal of allergy labels from the EMR and pharmacy records. Penicillin skin testing (ST) followed by an oral challenge remains the standard of care to remove the label of penicillin allergy. Despite a negative penicillin allergy evaluation, studies have shown persistence/re-documentation of penicillin allergy upon further follow-up. Inpatients and outpatients evaluated for penicillin allergy from 2012 to 2017 were identified from a retrospective chart review. Patients with a negative allergy evaluation (testing plus challenge) were contacted via phone to complete a follow-up survey regarding their awareness of results and whether they had any subsequent courses of penicillin/penicillin derivatives. Additionally, electronic charts were reviewed and the patient's pharmacy was contacted to assess if the penicillin allergy label remained. A total of 33 patients with a negative ST tolerated an oral challenge and were “de-labeled” of their penicillin allergy. Follow up was done with 24 de-labeled patients, and 96% (n=23) recalled the results of their testing accurately. Nine patients were unavailable for follow up. Nine patients reported tolerating subsequent courses of penicillin since their allergy evaluation; however 3 patients were still fearful of a possible reaction and continued to avoid penicillin. The penicillin allergy label was appropriately removed from the EMR in 66.6%(n=22) of patients, and from pharmacy records in 78.7%(n=26) of patients. Our study revealed that while penicillin allergy evaluation is safe and effective, there are barriers to removing the penicillin allergy label in clinical practice including patient apprehension and removal of allergy labels from the EMR and pharmacy records.