REPORTING FROM AAAAI/WAO JOINT CONGRESS
ORLANDO (FRONTLINE MEDICAL NEWS) – Using videoconferencing to assess patients for a reported penicillin allergy saved more than 2 hours of physician time for every patient, and resulted in almost every patient having their allergy label removed, researchers reported.
In what the researchers said was the first study showing the utility of telemedicine in evaluating patient-reported penicillin allergies, allergy and immunology physicians did a secure telemedicine consultation with patients after they underwent penicillin skin testing with a physician assistant; an approach which, on average, took 123 minutes fewer each time than if the physician had done the consultation face-to-face. The teleconference can be done on a laptop or smartphone.
Of 50 patients prospectively assessed with this approach over a 4-month period last year, 46 (92%) were delabeled, with $23,000 in direct antibiotic cost savings, or $360 per patient, said Allison Ramsey, MD , an allergist at Rochester Regional Health and at the University of Rochester (N.Y). presenting at the joint congress of the American Academy of Allergy, Asthma and Immunology and the World Asthma Organization.
She said the approach is sensible and effective, and it is a good alternative to the traditional way of doing these tests. “What this takes out of that is the travel part. Someone else is doing the travel and the technique of testing,” added that people often are labeled in childhood after getting a rash that was thought to be related to penicillin, but actually was just a coincidence that was unrelated. Then the false allergy label is attached to them for life.
“This is so overlabeled,” Dr. Ramsey said. “Ten percent of the population thinks they’re allergic to penicillin, and 90% of them are not.”
A stark difference was found in the types of medicines administered before and after the evaluations, with aminopenicillin therapy jumping from 0 days of use to 188 days, and vancomycin – a more potent, but more costly alternative – dropping from 130 days of use to 16 days (P less than .05 for both).
Dr. Ramsey noted that, in part because of the time-consuming nature of the penicillin skin tests, they often are simply not done, so the false allergy labels are not caught, leading to pointless costs and exposure to more potent and potentially harmful forms of antibiotic therapy.
“Some hospitals don’t have allergists who will come in to do testing,” she said. “Sometimes patients are on medications that may interfere. And then a lot of times it’s just underrecognized – the implications of a penicillin allergy label. That is a very hot topic in our field and also in infectious disease.”
She hopes the telemedicine approach catches on more widely, which would help minimize the multitude of problems linked to penicillin allergy labels.
“Patients that avoid penicillin, they’re on more costly second-line antibiotics that are, in general, less effective, depending on which infection you’re talking about,” Dr. Ramsey said. “The [second-line antibiotics] have more side effects. And there’s data to show that patients with [a] penicillin allergy label have longer hospital stays, more costly hospital stays, are at risk for more resistant infections. And it breeds antimicrobial resistance in the long-term.”
Dr. Ramsey had no relevant financial disclosures.
SOURCE: Ramsey AC et al. AAAAI/WAO Joint Congress, Abstract 104.
