De-labelling allergy patients to promote appropriate antibiotic use

Austin Health has found that of the patients with antibiotic allergies it has assessed as part of a Better Care Victoria Innovation Fund project, 25 per cent have a false penicillin allergy label.

In partnership with the Peter MacCallum Cancer Centre, Austin Health has identified (or 'discovered') 2,000 patients who have been admitted to its hospital with an antibiotic allergy 'label'. This means that at some stage in their medical history, the patient was deemed allergic to an antibiotic, however this label may not have been verified or updated since initial diagnosis. 

'Antibiotic allergies are like food and other types of allergies – people can grow out of them over time,' explains Associate Professor Jason Trubiano, Austin Health's Director of Antimicrobial Stewardship, Drug and Antibiotic Allergy Services. 

'Patients and their families often simply don't realise they are no longer allergic until we test them. These can be patients who have had a severe reaction in the past, including anaphylaxis, but for a variety of reasons are no longer carrying the allergy they once had.

‘Other times it is patients who have been wrongly diagnosed as allergic. They may have experienced nausea or another side effect after taking a certain antibiotic but this does not necessarily mean they are allergic.’

Austin Health has ‘de-labelled’ 500 of these 2,000 patients, either by verifying the allergy is false through testing or assessment alone. Certain low-risk allergies can be removed using tests such as an oral penicillin rechallenge, a simple, safe oral test dose procedure that has removed penicillin allergies in 98.9 per cent of those tested.

Assoc Prof Trubiano says, ‘Through our antibiotic allergy discovery and de-labelling program, we have seen a 10-fold increase in penicillin antibiotic use for de-labelled patients.

‘We know that antibiotic allergies are associated with use of second-line antibiotics – which may not be the most effective course of therapy available – and generation of superbugs, so removing them and allowing the use of penicillin is best for our patients.’

Antibiotic Awareness Week takes place from 18–24 November 2019. 

More than two million Australians report an antibiotic allergy, but studies have shown that 85–90 per cent of these reported allergies are false or can be removed by testing.

Having a false antibiotic allergy can lead to a patient receiving antibiotic therapies that are inappropriate for their condition, which can lead to poor health outcomes and unnecessary costs. It can result in lengthy hospital stays and related complications, increased antimicrobial resistance, increased hospital readmission rates, and, in some cases, even death.

By increasing access to vital antibiotic allergy testing, Austin Health and the Peter MacCallum Cancer Centre, with support from the Better Care Victoria Innovation Fund, aim to improve health outcomes for Victorians, and reduce the burden and cost of antibiotic allergies in healthcare.

Learn more about the antibiotic allergy discovery and de-labelling program.