Improving drug allergy management in Australia: education, communication and accurate information

Lucas, Michaela; Loh, Richard KS; Smith, William B

doi:10.5694/mja18.00467

Topics

Drug allergy education and effective communication of accurate information can optimise drug allergy management and patient safety

A drug allergy label is often applied to a patient after an adverse drug reaction (ADR), usually resulting in subsequent avoidance of the drug and related drugs. Recent attention has focused on antibiotic allergy labels and the benefits of delabelling.1 But drug allergy labels, which occur in up to 35% of patient electronic health records (EHRs), encompass all types of medications, with antibiotics, opiates and non-steroidal anti-inflammatory drugs being among the most common (Box 1).2 Accurate and effective communication of drug allergy is crucial for safe prescribing, including sufficient information to enable assessment of the risk of re-exposure compared with the risk of withholding the index drug and related drugs.

1 Sir Charles Gairdner Hospital, Perth, WA
2 Princess Margaret Hospital for Children, Perth, WA
3 Royal Adelaide Hospital, Adelaide, SA
4 AllergySA, Adelaide, SA

Correspondence: William.Smith@sa.gov.au

Acknowledgements:

We thank Sandra Vale, National Allergy Strategy coordinator, for her contribution to the drafting of this article. We also thank Connie Katelaris, James Yun, Maria Said, Andrew Lucas, Syed Ali and the members of the Australasian Society of Clinical Immunology and Allergy Drug Allergy Working Party for their contribution to this manuscript.

Competing interests:

No relevant disclosures.

1. Trubiano JA, Grayson ML, Thursky KA, et al. How antibiotic allergy labels may be harming our most vulnerable patients. Med J Aust 2018; 208: 469–470. https://www.mja.com.au/journal/2018/208/11/how-antibiotic-allergy-labels-may-be-harming-our-most-vulnerable-patients
2. Zhou L, Dhopeshwarkar N, Blumenthal KG, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy 2016; 71: 1305–1313.
3. Chaudhry T, Hissaria P, Wiese M, et al. Oral drug challenges in non‐steroidal anti‐inflammatory drug‐induced urticaria, angioedema and anaphylaxis. Intern Med J 2012; 42: 665–667.
4. Petitpain N, Argoullon L, Masmoudi K, et al. Neuromuscular blocking agents induced anaphylaxis: results and trends of a French pharmacovigilance survey from 2000 to 2012. Allergy 2018. https://doi.org/10.1111/all.13456. [Epub ahead of print]
5. Kemp HI, Cook TM, Thomas M, Harper NJN. UK anaesthetists’ perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey. Br J Anaesth 2017; 119: 132–139.
6. Florvaag E, Johansson SGO. The pholcodine case. Cough medicines, IgE‐sensitization, and anaphylaxis: a devious connection. World Allergy Organ J 2012; 5: 73–78.
7. Katelaris CH, Smith WB. “Iodine allergy” label is misleading. Aust Prescr 2009; 32: 125–128.
8. Mullins RJ, Wainstein BK, Barnes EH, et al. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46: 1099–1110.
9. Peter JG, Lehloenya R, Dlamini S, et al. Severe delayed cutaneous and systemic reactions to drugs: a global perspective on the science and art of current practice. J Allergy Clin Immunol Pract 2017; 5: 547–563.
10. Shah NS, Ridgway JP, Pettit N, et al. Documenting penicillin allergy: the impact of inconsistency. PLoS One 2016; 11: e0150514.
11. Morritt AN, Alexander DJ. Impact of junior doctor education on drug allergy documentation. Ann R Coll Surg Engl 2005; 87: 311–312.
12. Trubiano JA, Worth LJ, Urbancic K, et al. Return to sender: the need to re‐address patient antibiotic allergy labels in Australia and New Zealand. Intern Med J 2016; 46: 1311–1317.
13. Inglis JM, Caughey GE, Smith W, Shakib S. Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels. Intern Med J 2017; 47: 1292–1297.
14. Blumenthal KG, Shenoy ES, Hurwitz S, et al. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers’ antibiotic prescribing knowledge. J Allergy Clin Immunol Pract 2014; 2: 407–413.
15. Blumenthal KG, Shenoy ES, Varughese C, et al. Impact of a clinical guideline for prescribing antibiotics to inpatients with reported penicillin or cephalosporin allergies. Ann Allergy Asthma Immunol 2015; 115: 294–300.
16. Trubiano JA, Pai Mangalore RP, Baey YW, et al. Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study). Med J Aust 2016; 204: 273. https://www.mja.com.au/journal/2016/204/7/old-not-forgotten-antibiotic-allergies-general-medicine-agm-study

Online responses are no longer available. Please refer to our instructions for authors page for more information.