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Safety, efficacy and effectiveness of delabeling multiple drug allergy labels

Published online: September 20, 2020

Although few labels in the electronic health record (EHR) represent true allergy, patients with multiple drug allergy labels (MDAL), defined as 2 or more labels in the EHR are a burden to individual and public health. Traditional allergy testing procedures in this patient population would require multiple appointments with considerable time commitment leading to potential delays in essential treatment. In this study the authors aimed to assess the efficacy, safety and effectiveness of removing MDAL in a single clinic visit.

In this original research article by Vethody et. al, featured in The Journal of Allergy and Clinical Immunology: In Practice, the authors retrospectively reviewed charts of patients with MDAL, who were also delabeled to 1 or more drugs in clinic for a period of 4 years (from October 1, 2014 to October 31, 2018). Their primary outcome was the number of allergy labels tested and removed, at either single or multiple visits. To assess effectiveness of the delabeling process they also administered follow-up surveys to 184 patients, their pharmacies and primary care physicians (PCP) during a period of one year (from November 2, 2017 to October 31st, 2018).

Among 536 patients, 97.1% (916/943) of tested allergy labels were removed from the EHR.  86% of MDAL patients (461/536) were tested, challenged and delabeled safely in a single visit, to one or more drugs. However, 25% (134/536) still had evidence of one or more of the previously removed label(s) in their EHR at one year after the drug allergy clinic visit. Post clinic visit surveys showed 52.6% (90/171) of responding pharmacies and 72.6% (122/168) of PCPs contacted had removed drug labels from their EHR as a result of the recommendations from the patient’s drug allergy evaluation. Overall, 91/142 (64.1%) of MDAL patient survey respondents were willing to take the drugs to which they had been delabeled. Overall, a total of 112/390 (28.7%) patients tested and delabeled to penicillin had an EHR record of tolerating a 5 day or greater course of penicillin treatment. This study shows that although patients with MDAL can be safely delabeled to their drug allergies in one clinic visit, barriers like effective communication to patients, pharmacies and primary care providers were identified and present an area for improvement.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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