Scientific Publications Database

Article Title: Resource utilization and cost assessment of a proactive penicillin allergy de-labeling program for low-risk inpatients
Authors: Lanoue, Derek; Mir, Adhora; van Walraven, Carl; Olynych, Timothy; Nott, Caroline; MacFadden, Derek R.
Journal: ALLERGY ASTHMA AND CLINICAL IMMUNOLOGY Volume 20 Issue 1
Date of Publication:2024
Abstract:
BackgroundResource utilization and costs can impede proactive assessment and de-labeling of penicillin allergy among inpatients.MethodsOur pilot intervention was a proactive penicillin allergy de-labeling program for new inpatients with penicillin allergy. Patients deemed appropriate for a challenge with a low-risk penicillin allergy history were administered 250 mg amoxicillin and monitored for 1 h. We performed an explorative economic evaluation using various healthcare professional wages.ResultsOver two separate 2-week periods between April 2021 and March 2022, we screened 126 new inpatients with a penicillin allergy. After exclusions, 55 were appropriate for formal assessment. 19 completed the oral challenge, and 12 were directly de-labeled, resulting in a number needed to screen of 4 and a number needed to assess of 1.8 to effectively de-label one patient. The assessor's median time in the hospital per day de-labeling was 4h08 with a range of (0h05, 6h45). A single-site annual implementation would result in 715 penicillin allergy assessments with 403 patients de-labeled assuming 20,234 annual weekday admissions and an 8.9% penicillin allergy rate. Depending on the assessor used, the annual cost of administration would be between $21,476 ($53.29 per effectively de-labeled patient) for a pharmacy technician and $61,121 ($151.67 per effectively de-labeled patient) for a Nurse Practitioner or Physician Assistant.ConclusionA proactive approach, including a direct oral challenge for low-risk in-patients with penicillin allergy, appears safe and feasible. Similar programs could be implemented at other institutions across Canada to increase access to allergy assessment.