Implementation and Impact of a β-Lactam Allergy Assessment Protocol in a Veteran Population.

Abstract

BACKGROUND:

Approximately 10% of the US population reports having a β-lactam allergy, although nearly 90% do not have a true immunoglobulin E (IgE)-mediated reaction. This misconception results in using nonpreferred antibiotics, leading to antimicrobial resistance and treatment failure. To evaluate, clarify, and clear β-lactam allergies, we implemented a pharmacist-driven β-lactam allergy assessment (BLAA) protocol and penicillin allergy clinic (PAC). The purpose of this study was to illustrate the BLAA process, including the pharmacist-run PAC, and assess the impact on allergy clearance.

METHODS:

Clinical pharmacy specialists (CPS) evaluated hospitalized veterans with β-lactam allergies, using the BLAA protocol. Eligible patients could later be seen in PAC. This was a retrospective observational review of the BLAA protocol to assess recommendations for β-lactam antibiotic use and PAC outcomes.

RESULTS:

Between November 2017 and February 2020, 278 patients were evaluated, and 32 were seen in the clinic. The most common allergen was penicillin, and the most reported reaction was a rash (27%) or pruritus and urticaria (18%). Through PAC and the BLAA protocol, 86 patients (31%) were cleared for allergy removal, and 188 (68%) were cleared for alternative β-lactams. The evaluation revealed that 274 patients (99%) were eligible to receive a β-lactam antibiotic, and only 4 patients (1%) were recommended for avoidance of all β-lactams.

CONCLUSIONS:

These findings highlight the utility of the pharmacist-driven BLAA protocol. We illustrated that most patients with documented β-lactam allergies were eligible for alternative β-lactams. The implementation of the BLAA protocol and pharmacist-run PAC facilitated allergy clearance and has the potential to promote alternative β-lactam use.

• Authors: Anna B Mitchell, Rachel A Ness, Jessica G Bennett, Jarred E Bowden, Whitney V Elliott, Amanda R Gillion, Debendra N Pattanaik
• Journal: Federal practitioner : for the health care professionals of the VA, DoD, and PHS (Fed Pract) Vol. 38 Issue 9 Pg. 420-425 (Sep 2021) ISSN: 1078-4497 [Print] United States
• PMID: 34737539 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Frontline Medical Communications Inc., Parsippany, NJ, USA.