August 27, 2023

Availability and Efficacy of Assessment Strategies for Delabelling of Antibiotic Allergies, and the Role of the Pharmacist.

Key Points

De-labelling of antibiotic allergies improves antibiotic choices and reduces the need for broad-spectrum therapy.
The three-tiered skin prick test remains the gold standard, but many healthcare professionals in Australia lack access.
Assessment strategies utilize tools and algorithms to facilitate effective allergy evaluations by pharmacists.
Implementing allergy assessments can lead to reduced healthcare expenditures and better use of beta-lactam antibiotics.

Abstract

Background: Inaccurate antibiotic allergies are frequently reported in patients, limiting antibiotic choices when treating for an infection. This leads to inappropriate antimicrobial prescribing whereby second line therapy is often required, exposing the patient to more broad-spectrum antibiotics. With the current acceleration of antimicrobial resistance, allergy assessment has become an area of focus in antimicrobial stewardship. Aim: This narrative review aimed to evaluate the currently available and developing strategies used for antibiotic allergy de-labelling, the benefits of allergy de-labelling, and the emerging role of pharmacists in allergy assessments. Method: The search was conducted on Embase and Medline and involved three concepts: antibiotic allergy/ pseudoallergy, allergy de-labelling/assessment, and antimicrobial stewardship in clinical practice. Inclusion criteria included peer-reviewed journal articles written in English from 2013 to 2023. Relevant articles were retrieved by manual screening and citation chaining of the initial database output. Results: Of the results initially obtained, manual screening was able to refine to 28 relevant papers. 16 papers had implications in standard and in vivo allergy testing strategies, seven were related to screening tools and algorithms, and five were relevant to healthcare professional-led services. Conclusion: The three-tiered skin prick test/intradermal testing/oral challenge method is still considered to be the gold standard for antibiotic allergy de-labelling. However, in Australia this is still unavailable to a high percentage of healthcare professionals. Contributions from the antimicrobial stewardship team, including pharmacists, were shown in multiple studies to effectively facilitate allergy assessment and de-labelling. Allergy assessment has been proven to decrease the utilisation of restricted antimicrobials, to enhance prescribing of beta-lactam antibiotics, and reduce healthcare expenditures. Thus, clinicians should increase its utilisation in addition to risk stratification tools where relevant in clinical practice.

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