New research has found that there is a significant mismatch between the results of penicillin allergy tests and allergy labels in primary care, while there is a slightly lower mismatch between test results and hospital allergy labels.
These findings are significant because if allergies are wrongly disproved, patients may receive suboptimal treatment, longer hospital admissions, and an increased risk of antibiotic-resistant infections.
Investigations into penicillin allergy have revealed that up to 50% of patients may have inaccurate penicillin allergy labels in electronic medical records, making this a pressing issue.
This latest study was authored by Sara Fransson, from the Department of Dermatology and Allergy at Copenhagen University Hospital – Herlev and Gentofte in Denmark.
The primary aim of the research was to investigate the degree of match/mismatch between penicillin allergy labels in hospital and primary care EMR systems in patients who had undergone penicillin allergy investigation in a hospital allergy clinic.
The secondary objective was to examine the associations between various factors such as sex, type of reaction, age, general practitioner changes, and allergy investigation results, and the mismatch of labels.
The team used participants aged 18 years and above who were tested for allergies to penicillin at the Allergy Clinic, Gentofte Hospital between 2017 – 2019. Drug provocation tests were done using different penicillin types, and the results were recorded in the hospital’s electronic medical records.
Data regarding admissions, allergy labels, and current general practitioners were gathered from individual electronic medical records. It was discovered that there was a lack of standardized communication and formats for discharge letters and allergy labels in primary care.
The team sent a letter explaining the study protocol to GP clinics, and data was gathered through phone calls or secure emails. Allergy labels were considered to be a match if the third anatomical therapeutic chemical classification level matched, indicating any type of penicillin allergy registration in the records.
A logistic regression analysis was done to identify factors associated with the mismatch between testing results and GP clinic labels. Overall, a total of 849 individuals from 390 different GP clinics were identified, and data was obtained for 60% of the participants from 255 clinics.
Among the participants, 15.1% were found to have had confirmed penicillin allergy, while 84.9% had their penicillin allergy disproved. Confirmation rates for penicillin allergy were found to be 9% for males and 17% for females.
In the study, the research team reported that 26.0% of those with confirmed penicillin allergy were found not to have an allergy label in their primary care records, while 21.4% of patients with disproved allergy still had an incorrect label.
The odds of having a mismatch in the GP clinic were lower for males and for those with 3 or more admissions to hospitals since allergy testing. Sex, index reaction type, age, results of drug provocation test, GP changes, and number of GPs in the GP clinic did not show any association with the mismatch.
The researchers called for improvements in communication between healthcare sectors, such as follow-up phone calls, involvement of community pharmacists, or drug allergy passports, which have been suggested to improve communication.
In conclusion, this study demonstrates the need for greater consistency and standardization in allergy testing and labeling. Clinicians must be vigilant when working with patients who have a penicillin allergy, as an incorrect label can have negative consequences for patient health and wellbeing.
