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NewsAnnouncements : WRNMMC Program Tests Beneficiaries for Penicillin Allergy

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WRNMMC Program Tests Beneficiaries for Penicillin Allergy

02/24/2017

By Bernard S. Little

WRNMMC Public Affairs staff writer

“Are you allergic to any type of medication, such as penicillin?”

This is generally one of the first questions you are asked before receiving care from a health-care provider.
For approximately 10 percent of all U.S. patients, the answer is “yes” to having had an allergic reaction to a penicillin class antibiotic in their past, according to the Centers for Disease Control and Prevention (CDC). However, less than 1 percent of the whole population is truly allergic to penicillin, the CDC added.
“[In the military], this is also a readiness issue, as many active duty service members wear red dog tags indicating a likely non-existent penicillin allergy,” said Navy Lt. Cmdr. (Dr.) Taylor Banks, assistant service chief at Walter Reed National Military Medical Center for Allergy/Immunology/Immunizations. He is also clinic chief of WRNMMC Allergy/Immunology Clinic, and associate program director for the National Capital Consortium’s Allergy/Immunology Fellowship.
To better determine if service members and other Military Healthcare System beneficiaries are allergic to penicillin, Banks oversees WRNMMC’s Antibiotic Stewardship Program, which screens and tests individuals for penicillin allergy. He said approximately 95 percent of patients reporting penicillin allergy can be cleared, with many having outgrown the allergy.
“Providers and patients remain woefully under-informed about the availability of testing and how clearing patients is to the benefit [of the patient], as well as that of their providers and the health system generally,” Banks stated. “Penicillin allergy is associated with health-care costs of 9.5 times that of the testing itself,” he added.
“For the patient, it provides access to first-line agents which often have better side-effects profile and are better tolerated. For providers, it gives them access to the best practices which they can follow with the best recommendations [for treating] infections. For the health-care system, it provides enhanced antimicrobial stewardship,” Banks continued.
Discovered in 1928, penicillin is a group of antibiotics found to be effective against a number of bacterial infections caused by staphylococci and streptococci, such as pneumonia, erysipelas, strep throat, ear infections and more. Penicillin is also the base of other front-line drugs and when someone is allergic to it, he or she often has to take more expensive alternatives, which can produce increased side effects, thereby also increasing the chance for more hospital visits, Banks explained.
The WRNMMC’s Antibiotic Stewardship Program screens and tests beneficiaries “in a proactive fashion to optimize the availability of these often first-line, low-cost, low side-effect antibiotics to the 10 to 20 percent of patients labeled with an allergy,” said Banks.
Many people, such as Navy Lt. Preston Campbell, who Banks recently tested for penicillin allergy, are told they may have had an allergic reaction to penicillin, such as a rash or other side effects, at a young age. Most are unclear on the details of actually taking penicillin, Banks added.
Campbell explained he may have been about 10 years old when he experienced what he can recall as an allergic reaction to what may have been penicillin, which required an overnight stay in the hospital. He recalled having a rash and being nauseated.
Because of the passage of time, and usually individuals being told at such a young age they may have a penicillin allergy, people not recalling specific details of a possible allergic reaction is “pretty typical,” said Banks.
Screening and testing for penicillin allergy at WRNMMC includes a patient history, physical and, when appropriate, a skin test and/or challenge dose. Banks said the testing is “very safe.” Testing can take from one to two hours, and patients should avoid antihistamines for the five to seven days prior to their appointment, he added.
“We currently use a self-referral for active duty patients presenting to the Medical Readiness clinic and the Brigade Medical Clinic at the Naval Academy.  We are expanding our outreach with a pilot program in cooperation with the Internal Medicine Medical Home Ports.  Patients can also receive a referral through their provider for evaluation,” Banks said.
“Our dedicated penicillin clinic occurs weekly, but we also conduct testing and evaluation of patients who have referrals through our regularly scheduled clinic appointments,” he added.
 “Our patients, providers, and the MHS at large will all benefit [from the Antibiotic Stewardship Program] by understanding the capabilities of rigorous penicillin allergy assessment and testing and the manifold benefits of clearing patients of these reported allergies. We know we can do it successfully,” Banks said.
For more information about the Antibiotic Stewardship Program, call Lt. Cmdr. Taylor Banks at 301-295-4511.