antibiotic stewardship community hot topic penicillin allergy … · 4/23/2019 1 antibiotic...

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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.

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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.