Published online: May 8, 2018
Penicillin skin testing is the most reliable method to rule out penicillin allergy in appropriate patients. The significant risks associated with the penicillin allergy label, such as increased length of hospital stay, increased rates of resistant bacterial infections, and decreased infection cure rates, have prompted national organizations to recommend penicillin skin testing to patients with a penicillin allergy history. The limited availability of Allergy/Immunology practitioners, however, may be a barrier to providing penicillin skin testing services.
In The Journal of Allergy and Clinical Immunology: In Practice, Staicu et al. reported the results of their multidisciplinary study in a 528-bed community teaching hospital evaluating the use of telemedicine to assist with penicillin skin testing. A total of 50 patients underwent penicillin skin testing performed by a trained Allergy physician assistant. Upon completion, a telemedicine consultation was performed with an allergist who was located off-site. Patients were then surveyed about their telemedicine experience.
Patients rated their overall impression of and satisfaction with telemedicine for penicillin skin testing as an average of 4.4 and 4.5 on a scale of 1 (poor, highly unsatisfied) to 5 (excellent, highly satisfied). Forty-six patients (92%) had a negative skin test and tolerated an amoxicillin challenge. The average total physician time replaced by physician assistant time was about 2 hours per patient, including travel time to and from the hospital. The authors demonstrated a significant decrease in second-line antibiotic use, associated with a direct average cost savings of $360 per patient.
Telemedicine is an effective and novel approach to facilitate penicillin skin testing services and is associated with a high degree of patient satisfaction. This method has the potential to maximize and improve patient access to Allergy resources and services.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
The Use of Telemedicine for Penicillin Allergy Skin Testing
By Mary L. Staicu, Anne Marie Holly, Kelly M. Conn, Allison Ramsey