American Academy of Allergy, Asthma & Immunology
View all recommendations from this societyReleased March 3, 2014
Don’t overuse non-beta lactam antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.
While about 10 percent of the population reports a history of penicillin allergy, studies show that 90 percent on more of these patients are not allergic to penicillins and are able to take these antibiotics safely. The main reason for this observation is that penicillin allergy is often misdiagnosed and when present wanes over time in most (but not all) individuals. Patients labeled penicillin-allergic are more likely to be treated with alternative antibiotics (such as vancomycin and quinolones), have higher medical costs, experience longer hospital stays, and are more likely to develop complications such as infections with vancomycin-resistant enterococcus (VRE) and Clostridium difficile.
Evaluation for specific IgE to penicillin can be carried out by skin testing. Ideally, penicillin skin testing should be performed with both major and minor determinants. The negative predictive value of penicillin skin testing for immediate reactions approaches 100 percent, whereas the positive predictive value is between 40 and 100 percent. The usefulness of in vitro tests for penicillin-specific IgE is limited by their uncertain predictive value. They are not suitable substitutes for penicillin skin testing.
By identifying the overwhelming majority of individuals who can safely receive penicillin and penicillin-like drugs, we can improve the appropriateness of antibiotic therapy and clinical care outcomes.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Academy of Allergy, Asthma & Immunology (AAAAI) Executive Committee created a task force to lead work on Choosing Wisely consisting of board members, the AAAAI President and Secretary/Treasurer and AAAAI participants in the Joint Task Force on Practice Parameters. Through multiple society publications and notifications, AAAAI members were invited to offer feedback and recommend elements to be included in the list. A targeted email was also sent to an extended group of AAAAI leadership inviting them to participate.
The work group reviewed the submissions to ensure the best science in the specialty was included. Based on this additional members were recruited for their expertise. Suggested elements were considered for appropriateness, relevance to the core of the specialty, potential overuse of resources and opportunities to improve patient care. They were further refined to maximize impact and eliminate overlap, and then ranked in order of potential importance both for the specialty and for the public. Finally, the work group chose its top five recommendations which were then approved by the Executive Committee.
AAAAI’s disclosure and conflict of interest policy can be found at www.aaaai.org.
Sources
Solensky R, Khan DA. Drug allergy: an updated parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259–73.
Solensky R. Penicillin allergy as a public health measure. J Allergy Clin Immunol. 2013 Dec 8. pii:S0091 6749(13)01646–1.
Macy E, Contreras R. Healthcare utilization and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohortstudy. J Allergy Clin Immunol. 2013 Nov 1. pii:S0091–6749(13)01467–X.
Park MA, Markus PJ, Matesic D, Li JTC. Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol. 2006;97:681–7.
