Issue link: https://www.e-digitaleditions.com/i/1515319
Inhalation February 2024 35 tant Professor in the Division of Allergy and Immunology at Cincinnati Children's Hospital Medical Center. After obtaining a two-year grant from Pfizer in November 2022, the collabora- tion resulted in the development and introduction of "Penicil- lin Allergy Decision & Mobile Empowerment (PADME)," a patient-initiated, online platform designed to remove the penicillin allergy label from misdiagnosed pediatric patients. When a patient (or a pediatric patient's parents) uses PADME at https://chai-stage-padme.bioinf. unc.edu/, "a risk assessment sur- vey will pop up on-screen ask- ing the patient questions such as: What was the reaction after taking penicillin? Was there a rash only? Were there other symptoms? How long has it been since the reaction occurred? etc. After all questions have been answered, PADME will use a decision support algorithm to generate a risk certificate." Next the certificate should be given to a primary care doctor or an allergy specialist "who can help [the patient] perform the next steps of delabeling," explained Winslow. e platform is available at UNC Hospitals and Cincinnati Chil- dren's affiliated specialty clinics and primary care sites. However, "access to an allergist in the rural communities is far less likely than in places like the Raleigh-Durham- Chapel Hill area of North Caro- lina," added Kwan. "Part of the project is to gather more details about the practices that exist within these areas and demand for such delabeling services. is plat- form can be moved to rural loca- tions, and that has been a priority of ours—to extend the program to those communities." who have penicillin allergies on their charts but appear to be at low risk for an active allergy. In this type of allergy challenge, a pediatrician would give a patient a dose of penicillin in a doctor's office and observe them there for allergy symptoms. "Patients have a low risk of a true penicillin allergy if they had a reac- tion more than 10 years ago," Deal told the Post-Gazette, noting the majority of patients outgrow an allergy after more than a decade. "Patients are also at a low risk if they had a rash that wasn't hives, or if their reaction occurred more than a day after the first dose." A website to assist patients in delabeling An article in news.unchealthcare. org described a 2020 pilot program in the emergency department of the University of North Carolina School of Medicine that included screening of medical records for patients who had a penicillin allergy listed. e evaluation by Ashlyn Norris, PharmD, BCIDP, showed that up to 23-24% of patients could have their penicil- lin allergy label removed by the evaluation and medication record review (i.e., documentation of previous penicillin use with toler- ance). Additional testing or under- going an amoxicillin challenge by an allergist were not needed, noted Mildred Kwan, MD, PhD, Assis- tant Professor of Medicine, UNC School of Medicine and Director of Quality Improvement in the UNC Division of Rheumatology, Allergy, and Immunology, UNC Department of Medicine. "at experience sparked a real- ization that much more needed to be done to recognize a peni- cillin allergy. [Furthermore,] the importance of knowing a patient's true allergy history while offer- ing tools and ideas to help create awareness throughout healthcare offices, facilities, and communi- ties became the foundation" for a collaboration between Kwan and Andrew Winslow, MD, Assis- The penicillin family of antibiotics According to AAAAI, the penicillin family of antibiotics contains more than 15 chemically related drugs (e.g. penicillin, ampicillin, amoxicillin, amoxi- cillin-clavulanate, methicillin) given by mouth or injection for the treatment of many bacterial infections. It is one of the most frequently used classes of antibiotics in the world. How does mislabeling occur?' e Post-Gazette article described how penicillin mislabeling can take place. "Penicillin allergies are often marked into the medical record in early child- hood: Most enter a patient's chart before they turn 3. is often occurs because an infant or toddler is given antibiotics for a common illness, such as an ear infection or strep throat, and develops hives or another rash. Often- times, the hives are a symptom of the illness itself, and not a reaction to an antibiotic. But because of the possibility of an adverse reaction, [a penicillin allergy] is frequently entered onto the patient's chart, and often stays there for years, if not decades." About AAAAI e American Academy of Allergy, Asthma & Immunology (AAAAI) is a membership organization of more than 7,000 allergists/immunologists, other medical specialists, and allied health and related healthcare profes- sionals in 74 countries. It is also a resource for patients who have allergies, asthma and immune deficiency disorders. Its foundation, formerly the ARTrust™ supports the development of treatments and cures for allergic and immunologic disease through financial awards for education and research. AAAAI also publishes three journals, including the e Journal of Allergy and Clinical Immunology.