Pilot Study to Assess Outcomes of a Drug Allergy Clarification Service on a General Medicine Floor at a Local Community Hospital

Accuracy of Antibiotic Allergy Documentation and the Validity of Physicians' Decision in a Pediatric Tertiary Care Setting

Background

Patients allergic to antibiotics are at higher risk of receiving treatment with a broader spectrum, more harmful, and expensive agents. The aims of this study were (1) to assess the quality of documentation of antibiotics allergies in the electronic medical records (EMR) in a Pediatric tertiary care setting, and (2) to determine the validity of physicians’ decision to hold antibiotics prescriptions.

Methods

This is a retrospective cohort study at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia. A review of the EMR and all Adverse Drug Reaction (ADR) reports of pediatric patients 1–14 years old, with a documented allergy to antibiotics from June 2016 until June 2019. The quality of documentation of antibiotics allergy was assessed based on the presence of four parameters: 1) allergy alert notification, 2) allergy severity classification, 3) setting notes, and 4) symptoms’ description. In addition, all physicians’ reports of allergy to antibiotics were cross-classified according to their corresponding ADR reports, and the validity of physicians’ documentation of allergy was assessed.

Results

Of a total of 105 Pediatric patients’ EMR, documentation of antibiotics allergy was available in 98 (93.3%), with the presence of symptoms description (83%), allergy notes (87%), severity (67%), and signs of alert (50.8%). Overall documentation quality was good for only 23.5% of patients, while it was poor for 35.7%. Physicians’ documentation of antibiotics allergy was 0.82 sensitive [with 0.18 risk of allergy] and 0.60 specific [with 0.40 unnecessary restrictions of prescriptions]. Of all children with possible/actual allergies, only 38.9% were referred to the immunology clinic.

Conclusion

The quality of documentation of antibiotic allergy in children and the validity of physicians’ decisions are less than satisfactory. Therefore, improving communications between all healthcare providers regarding patients’ allergy status and follow-up for further assessment of the reaction is recommended to improve patient care.

Strategies for Clarifying Penicillin Allergies When Skin Testing Is Not an Option

Patients with reported penicillin allergies have been proven to experience negative health consequences, such as increased cost, suboptimal antimicrobial therapy, and adverse reactions. Though skin testing has been proposed as a method to clarify penicillin allergies, many institutions may lack the resources to perform skin testing on a wide scale. This literature review describes the current literature surrounding the use of penicillin allergy interviews when skin testing is not an option. Specifically, the review highlights the steps in carrying out a successful antibiotic allergy patient interview, summarizes the clinical evidence surrounding antibiotic allergy clarifications, and addresses key advantages and disadvantages of clarifying antibiotic allergies without the availability of skin testing.