- Testing for β-lactam allergies can be feasible in the emergency department (ED).
- The vast majority of patients in this single-center study did not have a hypersensitivity reaction (HSR).
Why this matters
- Most reported β-lactam allergies do not represent clinically important reactions.
- Unnecessarily avoiding β-lactams can compromise care.
- A history of penicillin allergy can result in longer time to first antibiotic dose.
- This study examines use in ED of antibiotic allergy testing pathways designed for and already in use with inpatients.
- ED is well-equipped to respond to allergic reactions.
- Test doses administered for:
- Cephalosporins (n=262; 85%).
- Penicillins (n=37; 12%).
- Carbapenems (n=11; 4%).
- HSRs occurred in 3.2% of patients (n=10).
- Reactions included anaphylaxis, throat closing, hypotension, and rash.
- Adherence was documented in 71% (n=219).
- Two-thirds of nonadherent cases comprised administration of test doses when a mild reaction permitted full dosing, per protocol.
- Single-center implementation study of penicillin and cephalosporin hypersensitivity test pathways in ED (n=310).
- ED provider ordered standardized 2-step test doses of antibiotic they wished to use.
- Outcomes: pathway compliance, HSRs, allergy documentation.
- Funding: Partners Quality, Safety, and Value; Partners Clinical Process Improvement Leadership Program.
- Small retrospective study.