For pharmacists, asking about allergies is a core component of their medicines management activities, such as assessing the clinical appropriateness of medicines, and medication history-taking, reconciliation and reviews. Patients often report general intolerances and side-effects as allergies.
Nearly 10 per cent of the general population claim to have a penicillin allergy, but it is actually confirmed in less than 10 per cent of that figure. Pharmacists, therefore, have an important role in clarifying and differentiating between allergies, and supporting patients by providing education and information.
A number of initiatives are underway in the NHS to tackle the issue of drug allergies, particularly allergies to penicillin. This is partly due to increasing evidence that an inappropriate or unconfirmed allergy status can lead to adverse events, either in terms of direct patient harm or due to poor clinical outcomes.
Studies and reviews of the impact of penicillin allergy warning labels report suboptimal antibiotic selection, increased costs, increased risk of surgical site infections and prolonged length of stay in hospital.
Antimicrobial stewardship programmes are beginning to consider the impact of allergy status on the appropriate and optimal use of antimicrobials. Recent efforts have focused on establishing allergy status more accurately so that appropriate actions may be taken.
NICE guidance [CG183] on drug allergy: diagnosis and management recommends that allergy status should be categorised as one of three options:
As part of my Improvement Science Fellowship, funded by the Health Foundation to investigate how to optimise the safety of antimicrobial prescribing in patients with known penicillin allergy, one of the aims is to develop a quality improvement toolkit to enable better communication and documentation of a patient’s allergies.
If you are or know a CCG or practice-based pharmacist interested in this area, please contact me for more information.
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This column is produced in association with the UKCPA. The views expressed are those of the author and are not necessarily those of either Pharmacy Magazine or the UKCPA.