Most Patients Inaccurately Self-Report Antibiotic Allergy

Pharmacists should double-check patients self-reporting allergies to ensure that they’re taking accurate and appropriate treatment.

A recent study presented at the American Academy of Allergy, Asthma, & Immunology (AACI) 2016 Annual Meeting investigated the extent to which self-reported allergies were actually true. To do so, researchers from the Cleveland Clinic compiled demographic and allergy data for outpatients and inpatients who received an “allergy” point-of-care assessment between August 1988 and August 2015.

The number of patients with self-reported allergies totaled nearly 1.5 million, and 47% of them claimed an allergy to beta-lactams, namely penicillin and amoxicillin. Other top-reported allergens were sulfa, codeine, morphine, seasonal allergies, aspirin, latex, contrast, and iodine.

Ultimately, however, the researchers observed an actual penicillin allergy in just 4.6% of cases analyzed, and those patients were predominantly male and primarily aged between 35 and 56 years. Nevertheless, “the overwhelming majority of self-reported ‘allergy’ involves antibiotic or analgesic medications,” the researchers wrote.

“These data highlight the substantial morbidity related to medications, particularly beta-lactams, withheld due to self-reported ‘allergy’ in a large tertiary care center population,” they concluded.

Patients who believe that they’re allergic to penicillin are typically given alternate antibiotics prior to surgery in order to ward off infection, but those alternatives can be more toxic, more expensive, and less effective.

Notably, previous studies have also shown that many patients who claim to have a penicillin allergy may not actually be allergic to the antibiotic. In fact, literature suggests that only 10% of patients labeled with a penicillin allergy have a true immunoglobulin E -mediated allergic reaction.

In 1 such study, researchers tested the skin of 38 patients at a particular medical center who claimed they were allergic to penicillin in order to determine whether the testing could help reduce the cost of expensive alternative antibiotics. Every patient in the study tested negative for penicillin allergy, which ultimately led the medical center’s staff to alter the medication regimen for 29 patients. Those changes significantly lowered the prescription costs for those patients, the researchers reported.

“When you are told you have an allergy to something, it's important to be seen and tested by an allergist who has the specialized training needed for accurate diagnosis and treatment,” ACAAI President-Elect James Sublett, MD, previously stated. “If you're truly allergic to a medication, your allergist will counsel you on an appropriate substitute.”’

Pharmacists can play a critical role in curbing inaccurate allergy reports by asking patients at the time of medication review whether they’ve sought the opinion of an allergist to confirm their allergy. Health systems should consider implementing guidelines to ensure such medication reconciliation occurs.