Published online: January 17, 2018
When a sick patient enters the hospital, one of the most important questions upon admission is “Are you allergic to any medications?” The answer to this question may change the way doctors treat their patients as they try to avoid medications patients list as allergies. A common response is a reported “allergy to penicillin” when in fact many people who think they are allergic to these drugs might actually be wrong. The American Academy of Allergy, Asthma & Immunology (AAAAI) actually advocates for penicillin allergy testing through a skin prick test procedure to verify whether or not the patient has a true allergy.
In a recent review of clinical studies published in The Journal of Allergy and Clinical Immunology: In Practice, Mattingly and colleagues investigated the costs and clinical outcomes reported in studies of patients with a reported penicillin allergy compared to those without. The authors identified 30 research articles that met their search criteria and summarized the methods used as well as the health outcomes and costs identified in each paper. The authors then categorized the most frequent outcomes and costs identified in existing research and provided brief descriptions of each.
The authors found that the majority of research articles comparing patients with penicillin allergy labels were observational studies focused on the treatments used and outcomes during a hospital stay. Most researchers defined “optimal therapy” for a specific infection or diagnosis and compared the proportion of patients that received the best therapy for their condition stratified by allergy history. While this approach may be helpful for us to understand the impact of a reported medication allergy on treatment decisions, it may not be able to answer whether or not verifying allergy labels during a hospital visit can have longer lasting impacts on patients well after they are discharged.
Penicillin allergy labels were shown to be associated with increased health care costs, often due to receipt of alternative antibiotics. Several studies in the review also found potential savings driven by shorter hospital stays in patients without a reported penicillin allergy. In addition to findings related to hospital care, studies estimate that the presence of a reported penicillin allergy is associated with higher costs from outpatient antibiotics. This suggests that a one-time skin test could provide longer term benefits.
The findings from this review help guide future studies evaluating the costs and benefits of penicillin allergy testing. Understanding the impact of removing an allergy label on outpatient treatments in addition to the changes to therapy while in the hospital may help determine the true value of expanded skin testing or making this confirmatory testing a part of routine practice.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.