1
|
Shah D, Chambliss JM, Nicolaides RE, Chow TG. Assessing socioeconomic and racial disparities in pediatric penicillin allergy testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2190-2192. [PMID: 38636592 DOI: 10.1016/j.jaip.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Devangi Shah
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jeffrey M Chambliss
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rory E Nicolaides
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy G Chow
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
2
|
Jacobs SR, Ramsey N, Bagnato M, Pitt T, Davis CM. Health disparities in allergic diseases. Curr Opin Allergy Clin Immunol 2024; 24:94-101. [PMID: 38295102 PMCID: PMC10923006 DOI: 10.1097/aci.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Healthcare disparities impact prevalence, diagnosis, and management of allergic disease. The purpose of this review is to highlight the most recent evidence of healthcare disparities in allergic conditions to provide healthcare providers with better understanding of the factors contributing to disparities and to provide potential management approaches to address them. This review comes at a time in medicine where it is well documented that disparities exist, but we seek to answer the Why , How and What to do next? RECENT FINDINGS The literature highlights the socioeconomic factors at play including race/ ethnicity, neighborhood, insurance status and income. Management strategies have been implemented with the hopes of mitigating the disparate health outcomes including utilization of school-based health, distribution of educational tools and more inclusive research recruitment. SUMMARY The studies included describe the associations between upstream structural and social factors with downstream outcomes and provide ideas that can be recreated at other institutions of how to address them. Focus on research and strategies to mitigate healthcare disparities and improve diverse research participant pools are necessary to improve patient outcomes in the future.
Collapse
Affiliation(s)
- Samantha R. Jacobs
- Department of Pediatrics
- Department of Medicine
- Division of Pediatric Allergy and Immunology
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicole Ramsey
- Department of Pediatrics
- Division of Pediatric Allergy and Immunology
| | | | - Tracy Pitt
- Department of Pediatrics, Humber Hospital, Toronto, Ontario, Canada
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine and Texas Children's Hospital
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Siddiqui Z, Lee BR, Nedved A, McKinsey J, Turcotte Benedict F, Missel B, Pandya A, El Feghaly RE. Pediatric penicillin allergy labels: Influence of race, insurance, and Area Deprivation Index. Pediatr Allergy Immunol 2024; 35:e14126. [PMID: 38610113 DOI: 10.1111/pai.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Zoya Siddiqui
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Brian R Lee
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Health Services and Outcome Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Amanda Nedved
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jennifer McKinsey
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Frances Turcotte Benedict
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Brandi Missel
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Aarti Pandya
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Rana E El Feghaly
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
4
|
DeZure C. Race-Based Medicine Is Racist. Pediatr Ann 2023; 52:e365-e367. [PMID: 37820704 DOI: 10.3928/19382359-20230829-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Race is a social construct and cannot be used as a biological proxy, inherently making race-based medicine racist. Given the history of slavery in the United States, there are deep-rooted racist laws and policies that have impacted the health of families and children of color for centuries. The American Academy of Pediatrics (AAP) has come to acknowledge its racist past and promised a more equitable future for children and its organization. White physicians from the days of slavery created false myths regarding biological differences between races to strengthen their argument for keeping the institution of slavery - some of which are still in use today. It is vital to the health of future generations of this country that there be a shift to practicing race-conscious medicine and addressing the social determinants of health that are responsible for inequitable care. Pediatricians can play a significant role in ensuring health care equity for children now and in the future. [Pediatr Ann. 2023;52(10):e365-e367.].
Collapse
|
5
|
Samarakoon U, Accarino J, Wurcel AG, Jaggers J, Judd A, Blumenthal KG. Penicillin allergy delabeling: Opportunities for implementation and dissemination. Ann Allergy Asthma Immunol 2023; 130:554-564. [PMID: 36563744 DOI: 10.1016/j.anai.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Although existing as a safety measure to prevent iatrogenic harm, unconfirmed penicillin allergy labels have a negative impact on personal and public health. One downstream effect of unconfirmed penicillin allergy is the continued emergence and transmission of resistant bacteria and their associated health care costs. Recognizing the consequences of inaccurate penicillin allergy labels, professional and public health organizations have started promoting the adoption of proactive penicillin allergy evaluations, with the ultimate goal of removing the penicillin allergy label when the allergy is disproved, also known as penicillin allergy "delabeling." A penicillin allergy evaluation includes a comprehensive allergy history often followed by drug challenge, sometimes with preceding skin testing. Currently, penicillin allergy delabeling is largely carried out by allergy specialists in outpatient settings. Penicillin allergy delabeling is performed on inpatients, albeit rarely, often at the time of need, as a point-of-care procedure. Access to penicillin allergy evaluation services is limited. Recent studies demonstrate the feasibility of expanding penicillin allergy evaluations and delabeling to internists, pediatricians, emergency medicine physicians, infectious diseases specialists, and clinical pharmacists. However, reducing the impact of mislabeled penicillin allergy will require comprehensive efforts and new investments. In this review, we summarize the current practices of penicillin allergy delabeling and discuss expansion opportunities for penicillin allergy delabeling as quality improvement.
Collapse
Affiliation(s)
- Upeka Samarakoon
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John Accarino
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Jordon Jaggers
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Allen Judd
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
6
|
Taylor MG, Joerger T, Anvari S, Li Y, Gerber JS, Palazzi DL. The Quality and Management of Penicillin Allergy Labels in Pediatric Primary Care. Pediatrics 2023; 151:e2022059309. [PMID: 36740967 PMCID: PMC10680064 DOI: 10.1542/peds.2022-059309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Penicillin allergy labels are the most common drug allergy label. The objective of this study was to describe the quality and management of penicillin allergy labels in the pediatric primary care setting. METHODS Retrospective chart review of 500 of 18 015 children with penicillin allergy labels born from January 1, 2010 to June 30, 2020 randomly selected from an outpatient birth cohort from Texas Children's Pediatrics and Children's Hospital of Philadelphia networks. Penicillin allergy risk classification ("not allergy," "low risk," "moderate or high risk," "severe risk," "unable to classify") was determined based on documentation within (1) the allergy tab and (2) electronic healthcare notes. Outcomes of allergy referrals and penicillin re-exposure were noted. RESULTS Half of penicillin allergy labels were "unable to classify" based on allergy tab documentation. Risk classification agreement between allergy tabs and healthcare notes was fair (Cohen's ĸ = 0.35 ± 0.02). Primary care physicians referred 84 of 500 (16.8%) children to an allergist, but only 54 (10.8%) were seen in allergy clinic. All children who were challenged (25 of 25) passed skin testing. Removal of allergy labels was uncommon (69 of 500, 13.8%) but occurred more often following allergy appointments (26 of 54, 48%) than not (43 of 446, 9.6%, P < .001). Children delabeled by primary care physicians were as likely to tolerate subsequent penicillin-class antibiotics as those delabeled by an allergist (94% vs 93%, P = .87). CONCLUSIONS Penicillin allergy documentation within the allergy tab was uninformative, and children were infrequently referred to allergists. Future quality improvement studies should improve penicillin allergy documentation and expand access to allergy services.
Collapse
Affiliation(s)
- Margaret G Taylor
- Division of Infectious Diseases
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Torsten Joerger
- Division of Infectious Diseases
- Division of Immunology, Allergy, and Retrovirology
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
- Division of Immunology, Allergy, and Retrovirology
| | - Yun Li
- Division of Immunology, Allergy, and Retrovirology
- Pediatric IDEAS Research Group of the Center for Pediatric Clinical Effectiveness
- Department of Biostatistics, Epidemiology, and Informatics
| | - Jeffrey S Gerber
- Division of Infectious Diseases
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debra L Palazzi
- Division of Infectious Diseases
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
7
|
Arasaratnam RJ, Chow TG, Liu AY, Khan DA, Blumenthal KG, Wurcel AG. Penicillin Allergy Evaluation and Health Equity: A Call to Action. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:422-428. [PMID: 36521831 DOI: 10.1016/j.jaip.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Allergists have been at the forefront of addressing the burden of unverified penicillin allergy labels. Coordinated national efforts with infectious diseases, antimicrobial stewardship experts, and pharmacy societies to advocate for formal evaluation of patient-reported penicillin allergy have resulted in improvements in delabeling efforts. Given the poorer health outcomes associated with the penicillin allergy label and the potential health benefits that can be gained with delabeling, improving access to penicillin allergy evaluation is of the utmost importance. Health disparities are widely recognized to impact all aspects of health care, and multilevel interventions at the patient, clinician, and systems level are required to ensure equitable care delivery. Structural racism underpins many social determinants of health and is a key driver of racial and ethnic health disparities. In this Rostrum, we use a conceptual framework from the 2015 National Academy of Medicine report Improving Diagnosis in Health Care to explore how inequities are related to the evaluation of penicillin allergy. We use the National Institute on Minority Health and Health Disparities Strategies to Advance Health Disparities to elucidate areas of important study. Building upon existing efforts to address disparities in Allergy/Immunology, we highlight the urgent importance of understanding and eliminating health disparities in penicillin allergy evaluation and delabeling.
Collapse
Affiliation(s)
- Reuben J Arasaratnam
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center and Veterans Affairs North Texas Health Care System, Dallas, Texas.
| | - Timothy G Chow
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Y Liu
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Mass; Tufts University School of Medicine, Boston, Mass
| |
Collapse
|
8
|
Gilliam C, Joerger T. Racism, Not Race: the Root of Racial Disparities in Penicillin Allergy Labeling. Hosp Pediatr 2022; 12:e266-e268. [PMID: 35661883 DOI: 10.1542/hpeds.2022-006695] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Courtney Gilliam
- Department of Pediatrics, Division of Hospital Medicine, Seattle Children's Hospital, Seattle, Washington, and
| | - Torsten Joerger
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, California
| |
Collapse
|