Syracuse, NY—Many patients who believe themselves to be allergic to beta-lactams haven’t actually demonstrated IgE-mediated reactions or type I sensitivity, according to a new study.
Furthermore, according to the report in the Journal of the American Pharmacists Association, most patients lose their sensitivity to penicillin over a 10-year period.
The dilemma is how to sort out the patients for whom those drugs actually are dangerous from those who just think they have an allergy or had only a minor reaction. Researchers from Upstate University Hospital in Syracuse sought to determine the effectiveness of a pharmacist-driven beta-lactam allergy interview on antimicrobial therapy.
“Clarification of beta-lactam allergy may expand treatment options for patients and potentially improve outcomes, reduce toxicity, and reduce costs,” study authors point out.
At a tertiary-care academic medical center, a pilot service using a pharmacy resident and infectious diseases clinical pharmacist was launched to help clarify beta-lactam allergy information and, where appropriate, recommend a change to the patient’s antibiotic therapy.
As part of the program, adult patients who had a documented beta-lactam allergy who had received nonpenicillin antibiotics and who had undergone a beta-lactam allergy interview were identified through pharmacy-intervention data, with pharmacists employing an internally developed allergy questionnaire in the interviews. Ultimately, recommendations for beta-lactam therapy were made to the patient’s primary medical team based on the results of the allergy interview and factors including infection type and culture results.
The goal of the study was to determine the percentage of patients successfully switched to beta-lactam therapy as a result of the drug-allergy interview, to identify allergy discrepancies between the electronic medical record (EMR) and the pharmacist’s interview, and to quantify the acceptance rate of the pharmacist’s antimicrobial recommendations after drug-allergy clarification.
Overall, 32 patients were interviewed, and 24 were determined to be candidates for a beta-lactam recommendation. Results indicate that, as a result of the interview, 21 patients (65.6%) were successfully switched from a nonpenicillin antibiotic to a cephalosporin, carbapenem, or penicillin. A discrepancy between the EMR-reported allergy and history obtained on interview was identified in 11 patients (34.4%).
Medical providers accepted 87.5% of pharmacists’ antimicrobial recommendations.
“A pharmacist-driven beta-lactam allergy interview was effective in switching eligible patients to beta-lactam therapy and identifying discrepancies between EMR-documented allergies and confirmed allergies,” study authors conclude. “Antimicrobial recommendations were well received by medical providers with a high acceptance rate.”
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