Abstract
Background Patients labelled with penicillin allergy usually receive alternative second-line or broad-spectrum antimicrobial therapy, which is often more costly, potentially more toxic, and linked to an increased risk of bacterial resistance.1 A significant proportion of individuals labelled as penicillin allergic do not actually have a true allergy and test negative on skin assessments.1 2 Therefore, the primary objective of this initiative was to assess 90% of patients labelled with penicillin allergy, admitted under the medical service at Hamad General Hospital in Qatar using a standardised assessment tool to categorise these patients based on their actual risk of allergies.
Methods A collaborative effort between the Allergy/Immunology and Pharmacy departments led to the development and implementation of a novel standard pathway for assessing penicillin allergies. Five clinical pharmacists underwent training on the risk stratification tool and systematically applied it to all hospitalised patients labelled with a penicillin allergy. This involved gathering necessary patient history and information to appropriately stratify them based on the assessment tool.
Results Over a 9-month period from March 2023 to November 2023, clinical pharmacists reviewed a total of 462 patients, achieving a target of ≥90% for the last consecutive 6 months (figure 1). Among them, 109 patients were referred to the allergy clinic for further testing, and 19 patients were directly de-labeled by the allergist upon referral from the clinical pharmacist (figure 2).
Conclusion Clinical pharmacists’ review of patients labeled as penicillin allergic played a crucial role in stratifying them based on allergic risk. The next step would include extending the service to include all patients admitted to Hamad General Hospital and other facilities.
Percentage of assessed patients by clinical pharmacist at Hamad general hospital
Number of assessed penicillin allergic patients and their risk category
References
Bhogal R, Hussain A, Balaji A, et al. The role of a clinical pharmacist in spurious Penicillin allergy: a narrative review. Int J Clin Pharm. 2021 Jun;43(3):461–475. doi: 10.1007/s11096-020-01226-7.
Chen JR, Khan DA. Evaluation of penicillin allergy in the hospitalized patient: opportunities for antimicrobial Stewardship. Curr Allergy Asthma Rep. 2017 Jun;17(6):40. doi: 10.1007/s11882-017-0706-1.
Ethical Approval/IRB Statement This is a quality improvement project approved by Head of Allergy and Immunology Department and Pharmacy Department.
Disclosures and Acknowledgements The authors have nothing to disclose.
