Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T03:16:48.818Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence of interruptive penicillin allergy alerts in patients with previously documented beta-lactam exposure: Potential for leveraging the electronic health record to identify erroneous allergies

Published online by Cambridge University Press:  13 August 2021

Nicole Van Groningen Open the ORCID record for Nicole Van Groningen [Opens in a new window] ,
Ray Duncan ,
Galen Cook-Wiens ,
Aaron Kwong ,
Matthew Sonesen ,
Teryl K. Nuckols ,
Suzanne L. Cassel  and
Joshua M. Pevnick
Nicole Van Groningen*
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Ray Duncan
Affiliation:
Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Galen Cook-Wiens
Affiliation:
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
Aaron Kwong
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Matthew Sonesen
Affiliation:
Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Teryl K. Nuckols
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Suzanne L. Cassel
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Joshua M. Pevnick
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
*
Author for correspondence: Nicole Van Groningen, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non–β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure.

Objective:

To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure.

Design:

Retrospective EHR review from January 2013 through June 2018.

Setting:

A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics.

Participants:

All patients with EHR-documented of penicillin allergies.

Methods:

We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic.

Results:

Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam.

Conclusions:

Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1108 - 1111
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Zhou, L, Dhopeshwarkar, N, Blumenthal, KG, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy 2016;71:1305–1313.CrossRefGoogle ScholarPubMed
Shenoy, ES, Macy, E, Rowe, T, Blumenthal, KG. Evaluation and management of penicillin allergy: a review. JAMA 2019;321:188–199.CrossRefGoogle ScholarPubMed
Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010;105:259–273.CrossRefGoogle Scholar
Pawlasty, HM, Thompson, AJ, Chalmers, L. Rates and consequences of false penicillin allergies in Australia. JAMA Intern Med 2017;177:1061.CrossRefGoogle ScholarPubMed
Rubin, R. Overdiagnosis of penicillin allergy leads to costly, inappropriate treatment. JAMA 2018;320:1846–1848.CrossRefGoogle ScholarPubMed
Blanca, M, Romano, A, Torres, MJ, et al. Update on the evaluation of hypersensitivity reactions to β-lactams. Allergy 2009;64:183–1937.CrossRefGoogle Scholar
Blumenthal, KG, Lu, N, Zhang, Y, Li, Y, Walensky, RP, Choi, HK. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ 2018;361. doi: 10.1136/bmj.k2400.Google ScholarPubMed
Macfadden, DR, Ladelfa, A, Leen, J, et al. Impact of reported β-lactam allergy on inpatient outcomes: a multicenter prospective cohort study. Clin Infect Dis 2016;63:904–910.CrossRefGoogle ScholarPubMed
Macy, E, Contreras, R. Healthcare use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014;133:790–796.CrossRefGoogle ScholarPubMed
Mattingly, TJ, Fulton, A, Lumish, RA, et al. The cost of self-reported penicillin allergy: a systematic review. J Allergy Clin Immunol Pract 2018;6:1649–1654.CrossRefGoogle ScholarPubMed
Sousa-Pinto, B, Cardoso-Fernandes, A, Araújo, L, Fonseca, JA, Freitas, A, Delgado, L. Clinical and economic burden of hospitalizations with registration of penicillin allergy. Ann Allergy Asthma Immunol 2018;120:190–194.CrossRefGoogle ScholarPubMed
Picard, M, Bégin, P, Bouchard, H, et al. Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital. J Allergy Clin Immunol Pract 2013;1:252–257.CrossRefGoogle Scholar
Fast facts on US hospitals, 2020. American Hospital Association website. https://www.aha.org/statistics/fast-facts-us-hospitals. Published 2020. Accessed October 20, 2020.Google Scholar
Ambulatory care use and physician office visits. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/fastats/physician-visits.htm. Accessed October 20, 2020.Google Scholar
Emergency department visits. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/fastats/emergency-department.htm. Accessed October 20, 2020.Google Scholar
Tucker, MH, Lomas, CM, Ramchandar, N, Waldram, JD. Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of Marine recruits. J Allergy Clin Immunol Pract 2017;5:813–815.CrossRefGoogle Scholar
Iammatteo, M, Alvarez Arango, S, Ferastraoaru, D, et al. Safety and outcomes of oral graded challenges to amoxicillin without prior skin testing. J Allergy Clin Immunol Pract 2019;7:236–243.CrossRefGoogle ScholarPubMed
Supplementary material: File

Van Groningen et al. supplementary material

Van Groningen et al. supplementary material

Download Van Groningen et al. supplementary material(File)
File 77.7 KB