Penicillin Allergy Testing: AAAAI Advocacy Priority

March 2018
AAAAI Endorses STAAR Act

The AAAAI recently endorsed in coalition with others the reintroduction of the Strategies to Address Antimicrobial Resistance (STAAR) Act, sponsored by Senator Sherrod Brown. Antimicrobial resistance is a complex problem that requires a multi-faceted solution including investments in surveillance and data collection, antimicrobial stewardship and research.

Overuse and misuse of antimicrobial drugs drives the development of resistance. The AAAAI advocates for the increased use of penicillin allergy testing to mitigate the emergence and spread of antibiotic resistance and to ensure the continued availability of effective therapeutics for the treatment of bacterial infections.

Senators Send Letter to Secretary Azar Regarding Penicillin Allergy
AAAAI President Robert A. Wood, MD, FAAAAI, discussed the role that verification of patient-reported penicillin allergy can play in the antimicrobial resistance crisis with Senator Benjamin Cardin during a Congressional visit last fall. That discussion lead to a letter sent by Senator Cardin, and joined by Senators Orrin Hatch and Michael Bennet, to the Secretary of the Department of Health and Human Services (HHS), Alex Azar, addressing the issue. The letter calls for HHS to engage in the following:

•    Development of guidelines or protocols to increase penicillin allergy testing and desensitization
•    Implement recommendations from the 2015 National Institutes of Health report on drug allergy
•    Support development of hospital- and community-based programs educating patients and providers, and
•    Encourage use of quality measures and other federal safety standards to increase verification of penicillin allergy.

Encouraging verification of patient-reported penicillin allergy as a means of combatting antimicrobial resistance is an advocacy priority of the AAAAI. We will continue to keep you updated.


Presidential Advisory Council on Combatting Antibiotic-Resistant Bacteria (PACCARB)

U.S. Stakeholder Forum on Antimicrobial Resistance (S-FAR)

The American Academy of Allergy, Asthma & Immunology (AAAAI) advocates for the increased use of penicillin allergy testing to mitigate the emergence and spread of antibiotic resistance and to ensure the continued availability of effective therapeutics for the treatment of bacterial infections. As clinicians dedicated to the advancement of the knowledge and practice of allergy, asthma and immunology for optimal patient care, the AAAAI recommends patients who believe they have a penicillin allergy or who have documentation in their health record regarding a penicillin allergy should undergo skin prick testing to verify if they are truly allergic to penicillin, before an alternative non-penicillin antibiotic is prescribed. As many as nine of 10 patients who are tested actually do not have an allergy to penicillin.

According to published research, without testing, an unverified history of penicillin allergy can contribute to longer hospitalizations, higher costs, greater risk for adverse effects of alternative (non beta lactam) antibiotics, and increased rates of serious antibiotic resistant infections such as C.difficile and methicillin-resistant Staphylococcus aureus (MRSA). Penicillin allergy testing is safe, effective, and can be performed even in critically ill patients and pregnant women.

As part of the American Board of Internal Medicine Choosing Wisely® program, the AAAAI recommended in 2014 that physicians should not overuse non-beta-lactam antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.  

The AAAAI has included in its Quality Clinical Data Registry a quality measure on appropriate removal or confirmation of indication of penicillin allergy from a patient’s medical record. A variation of this measure has been shared with a national work group developing quality measures designed to combat antimicrobial resistance.

The AAAAI advocates that federal policies to address the growing threat of antimicrobial resistance should:
• Establish a national strategy working through the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other Federal agencies to encourage penicillin allergy testing to reduce the large number of patients mislabeled as allergic to penicillin;
• Develop and adopt quality measures, Medicare Conditions of Participation (CoPs), and other federal health and safety standards that target a variety of settings to encourage correct identification of penicillin allergies; and
• Implement the recommendations contained within the Report from the National Institute of Allergy and Infectious Diseases Workshop on Drug Allergy.  

In addition, the AAAAI continues to promote the increased use of penicillin allergy testing in traditional and social media.

The AAAAI Board of Directors identified penicillin allergy testing as an advocacy priority stating, “Without such testing, there is an unrealized opportunity to improve healthcare outcomes and reduce rising rates of antibiotic resistance.”

Presidential Advisory Council on Combatting Antibiotic-Resistant Bacteria (PACCARB)

the AAAAI submitted this information for the May 3 & 4, 2017 meeting of the Presidential Advisory Council on Combatting Antibiotic-Resistant Bacteria.
 

U.S. Stakeholder Forum on Antimicrobial Resistance (S-FAR)

AAAAI Among Sponsors of Hill Briefing on Antibiotic Resistance, New Report
AAAAI was one of the sponsors of a Hill Briefing hosted by the Infectious Diseases Society of America (ISDA), in collaboration with the U.S. Stakeholder Forum on Antimicrobial Resistance (S-FAR), of which the AAAAI is a member organization. Speakers included the Center for Disease Control and Prevention’s acting director, Anne Schuchat, MD, who presented at the U.S. Capitol about the need for continued action and investment to contain and address the urgent threat of antibiotic resistance to protect Americans.
 
IDSA, with support from several S-FAR member organizations including the AAAAI, also released the Faces of Antimicrobial Resistance report—featuring important and personal stories of patients and their families who battle the threat of antibiotic resistance every day. AAAAI continues to advocate for the increased use of penicillin allergy testing to mitigate the emergence and spread of antibiotic resistance and to ensure the continued availability of effective therapeutics for the treatment of bacterial infections. Read more.

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