Cincinnati Children’s will begin offering a daily afternoon clinic in November for patients who identify as being allergic to penicillin. The daily Penicillin Allergy Testing Service (PATS) is the brainchild of Kimberly Risma, MD, PhD, associate professor, Allergy and Immunology. It will be run by Risma and newly hired Trisha Wendling, DNP, APRN, CNP, nurse practitioner, through the Division of Allergy and Immunology.
“We know that about 95 percent of patients who are labeled allergic to penicillin probably are not,” said Risma. “Unfortunately, when patients have that designation, we are required to use costlier antibiotics that potentially have more side effects. So the better we are at accurately identifying who has a true penicillin allergy, the better the outcome will be. And for those who were incorrectly identified as allergic, we’ve opened up a whole class of medication for them should they need it.”
Said Wendling, “Typically, patients will say they have a penicillin allergy because they develop a rash while taking it. But in pediatrics, we know children can develop a rash for many reasons and it may or may not be related to the antibiotic they are taking. If they are on an antibiotic, they have some kind of virus or bacteria which could be the cause for the rash. Also, children get rashes more easily than adults. It’s just the way their bodies respond.”
According to Risma, the testing is simple and should be offered to all children who are labeled as having a penicillin allergy (about 10 percent of our patients). Patients receive amoxicillin (the most commonly prescribed form of penicillin), and staff observe them for an hour to make sure there is no reaction. Occasionally, they will administer a skin test before the amoxicillin if there’s a history of more serious symptoms.
The Penicillin Allergy Testing Service also provides a more affordable and efficient option for parents who bring their children to the ED with concerns about a penicillin-related rash.
Said Risma, “Every day, patients come to the ED who are being treated with amoxicillin and have a rash, like hives and perhaps lip/eye swelling. In the winter, it may be two or three patients a day, and they often return the next day with more concerns. We will intentionally hold clinic slots open for these patients who have an acute need to be seen. Typically, caregivers simply need a clear plan for symptom relief and information on how long the condition will last.”
The PATS team will do inpatient consults, as well, in collaboration with the Antibiotic Stewardship Program, with leadership from Josh Courter, PharmD, clinical specialist, Pharmacy, and inpatient faculty from Hospital Medicine.
“If a patient is not on the preferred antibiotic for their infection because of a penicillin allergy, we will evaluate and test while they’re in-house and hopefully get them on a more appropriate medication,” said Wendling.
An urgent need
An accurate assessment of penicillin allergy is important from a public health standpoint, Risma pointed out. “As we use increasingly complicated antibiotics because of allergy labels, the price of healthcare goes up. It would be far better for you to take amoxicillin for your strep throat, ear or sinus infection than to take what we call “big gun” antibiotics that will, in most cases, cause diarrhea and increase the likelihood of bacterial resistance in the community.”
The clinic will be open from 1 to 5 pm, Monday through Friday, at various locations across the Burnet Campus, including the Multipractice Center and the ENT, Nephrology, Urology, Allergy and Pulmonology clinics. To refer patients, call the Scheduling Center at 513-636-5447 and put in an ambulatory request for PATS. Be sure to ask specifically for the Penicillin Allergy Clinic. For more information, call 513-517-PATS (7287) or send an email to PATS@cchmc.org.
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