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Antibiotic Stewardship Community Hot Topic:
Penicillin Allergy Testing
Katie Burenheide Foster, PharmD, MS, FCCMPharmacy Clinical Manager
Stormont Vail Health
Objectives
• Identify criteria for identifying penicillin allergy.
• Identify alternatives to penicillin antibiotics
• Identify penicillin testing options
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https://www.penallergytest.com/implementation-2/
PenAllergy Testing
“I had a penicillin allergic reaction when I was a child”
Children whom receive amoxicillin or ampillicin and have Epstein-Barr virus infection can develop a non-allergic, non-pruritic rash that can appear similar to an allergic reaction
https://www.cdc.gov/antibiotic-use/community/for-hcp/Penicillin-Allergy.html
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https://www.penallergytest.com/implementation-2/
https://www.penallergytest.com/implementation-2/
Know the Facts about Antibiotic Resistance
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Why are Penicillin Antibiotics so important
since there are other antibiotic classes available?
Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy.JAMA 2019; 32(2):188-199.
![Page 5: Antibiotic Stewardship Community Hot Topic Penicillin Allergy … · 4/23/2019 1 Antibiotic Stewardship Community Hot Topic: Penicillin Allergy Testing Katie Burenheide Foster, PharmD,](https://reader031.vdocuments.site/reader031/viewer/2022020416/5d42746188c99363498d58e0/html5/thumbnails/5.jpg)
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Pongdee T, Li JT. Evaluation and Management of Penicillin Allergy. Mayo Clin Proc. 2018 Jan; 93 (1):101-107
Cross-Reactivity?
Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
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https://resistancemap.cddep.org/
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http://www.qualityforum.org/Publications/2016/05/Antibiotic_Stewardship_Playbook.aspx?utm_source=external&utm_medium=link&utm_term=ABX&utm_content=Playbook&utm_campaign=ABX –Quality Forum Web site
Penicillin Allergy Patient Outcomes
Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
Need to Obtain a Thorough Patient History
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
Identifying if Truly Penicillin Allergic
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
Amoxicillin Allergy Testing with Skin Test
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
Amoxicillin Oral Challenge without Skin Testing
PrePen Skin Testing
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Penicillin Allergy Testing: https://www.penallergytest.com/why-penicillin-allergy-testing/
Penicillin Skin Testing
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J Allergy Clin Immunol Pract 2014;2:439-44
• Indicated for ages 18 and up
• Cost of testing
PrePen
PrePen Skin Testing
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
PrePen Testing
Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
Skin Testing
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https://www.penallergytest.com/why-penicillin-allergy-testing/ - Link to Penicillin Allegry Testing
Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
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https://www.penallergytest.com/implementation-2/train-the-trainer-program/
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Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 32(2):188-199
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Desensitization Example (Patient specific)
Patient Handouts
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?
I am Allergic to Penicillin
References• Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and
Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259-273.
• Gonzalez-Estrada A, Radojicic C. Penicillin allergy: a practical guide for clinicians. Cleve Clin J Med. 2015 May;82(5):295-300.
• Herrier RN, Apgar DA, Boyce RW, Foster SL. Patient assessment in pharmacy. New York: McGraw-Hill; 2015 [cited 2015 Aug 14]. Available from: http://accesspharmacy.mhmedical.com/content.aspx?bookid=1074&Sectionid=62364288External.
• Bernstein JA. Update on angioedema: evaluation, diagnosis, and treatment. Allergy Asthma Proc 2011; 32(6):408-412.
• Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A et al. Second symposium on the definition and management of anaphylaxis: summary report–second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006; 47:373-380.
• Blumenthal KG, Shenoy ES, Hurwitz S, Varughese CA, Hooper DC, Banerji A. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers’ antibiotic prescribing knowledge. J Allergy Clin Immunol. 2014;2(4):407-412.
• Macy E, Ngor E. Recommendations for the management of beta-lactam intolerance. Clinical Rev Allerg Immunol. 2014; 47:46-55.
• Pichichero, ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr; 115(4):1048-1057.
• Centers for Disease Control and Prevention [Internet]. About Epstein-Barr Virus (EBV) [cited 2015 Aug 17]. Available from: http://www.cdc.gov/epstein-barr/about-ebv.html.
• CDC Evaluation and diagnosis of penicillin allergy for healthcare professionals. https://www.cdc.gov/antibiotic-use/community/for-hcp/Penicillin-Allergy.html
• Pongdee T, Li JT. Evaluation and Management of Penicillin Allergy. Mayo Clin Proc. 2018 Jan; 93 (1):101-107 • Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy.JAMA 2019;
32(2):188-199.