Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
A common source of confusion and discomfort of medical treatment for infected patients with antibiotics is optimizing therapy for patients with allergies. Approximately 15% of hospitalized patients have been found to report beta lactam allergies with many of these reactions being unknown or a cutaneous reaction. An important aspect of antimicrobial stewardship is clarification of beta lactam allergies. Mis-labeling of beta lactam allergies or documenting that a patient has a beta lactam allergy has been found to have harmful effects on patients. Pharmacists can have a large role in de-labeling these allergies. In other words, further investigating reported allergies, removing/properly documenting allergies that are not true in patient electronic medical records, and pursuing allergy testing can greatly benefit patients. The literature has shown that true beta lactam cross reactivity is low and likely due to similarities in side chain structure rather than the beta lactam ring. This presentation seeks to emphasize the importance of clarifying and documenting beta lactam allergies and will provide the audience with a better understanding of how to apply this knowledge to ensure patients are receiving the most appropriate antibiotic therapy. This presentation will provide a review of the existing literature regarding the evaluation and management of penicillin allergies, oral amoxicillin challenge and penicillin skin testing, the role of pharmacists in de-labelling allergies, completing allergy histories, and the impact of utilizing an institutional clinical guideline. Additionally, practical application of this information to patients at UPMC Presbyterian will be reviewed with the introduction of the new beta-lactam allergy pathway.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe harms associated with penicillin allergy mislabeling.
• Define the types of hypersensitivity reactions.
• Discuss the existing literature regarding β-lactam cross reactivity, penicillin allergy de-labeling, and allergy testing.
• Explain the pathways for optimal evaluation and management of penicillin allergies.

Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is 0481-0000-19-113-H04-P.

Suggested Additional Reading:

1. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy A Review. Journal of the American Medical Association. 2019;32(2):188-199.
2. Blumenthal KG, Peter JG, Trubiano JA, Philips EJ. Antibiotic allergy. The Lancet. 2019;393(10167):183-198.
3. Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Open Forum Infectious Diseases. 2018;66(3):329-336. doi:10.1093/ofid/ofx163.1723.
4. Moussa Y, Shuster J, Matte G, et al. De-labeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis. Surgery. 2018;164(1):117-123. doi:10.1016/j.surg.2018.03.004.
5. Antunez C, Blanca-Lopez N, Torres MJ, et al. Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins. The Journal of Allergy and Clinical Immunology. 2006;117(2):404-410. doi:10.1016/j.jaci.2005.10.032.
6. Depestel DD, Benninger MS, Danziger L, et al. Cephalosporin use in treatment of patients with penicillin allergies. Journal of the American Pharmacists Association. 2008;48(4):530-540. doi:10.1331/japha.2008.07006.Eljaaly K, Stevens R. Penicillin Allergies and Cross-Reactivity With Other Beta-Lactams. The Pharmacy Times . May 2017.
7. Goodman EJ, Morgan MJ, Johnson PA, Nichols BA, Denk N, Gold BB. Cephalosporins can be given to penicillin-allergic patients who do not exhibit an anaphylactic response. J Clin Anesth. 2001;13(8):561-564.
8. Herbert ME, Brewster GS, Lanctot-Herbert M. Medical myth: ten percent of patients who are allergic to penicillin will have serious reactions if exposed to cephalosporins. West J Med. 2000;172(5):341.
9. Daulat SB, Solensky R, Earl HS, Casey W, Gruchalla RS. Safety of cephalosporin administration to patients with histories of penicillin allergy. J Allergy Clin Immunol. 2004;113(6):1220-1222.
10. Prescott WA Jr, DePestel DD, Ellis JJ, Regal RE. Incidence of carbapenem-associated allergic-type reactions among patient with versus patients without a reported penicillin allergy. Clin Infect Dis. 2004;38(8):1102-1107.
11. Torres MJ, Adkinson NF, Caubet JC, Khan DA, Kidon MI. Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing. American Academy of Allergy, Asthma and Immunology. 2018;7(1):40-45.