Minimum standards for drug allergy de-labelling
The National Allergy Strategy is developing minimum standards for drug allergy de-labelling or confirmation of drug allergy.
Many people are considered to be allergic to one or more drugs, most commonly antibiotics, usually because they have had adverse symptoms or a reaction whilst taking the drug. In some cases, this is valid, and the drug should be avoided. However, in many cases the person is not truly allergic because the symptoms were not actually caused by the drug, but rather the illness they had at the time (e.g. virus). Furthermore, the perception of allergy might be based on childhood reactions that are no longer relevant, or on entirely spurious information (e.g. the wrong drug, or a family member with allergy).
Confirmation or clarification of drug allergy reduces costs by allowing basic, safe and cheaper drugs (particularly antibiotics) to be used in those who are not allergic, which might otherwise be avoided unnecessarily. It prevents complications, results in shorter hospital stays, reduces readmissions and reduces the rate of bacterial antimicrobial resistance (in the case of antibiotics) in the community.
Developing minimum standards will help to standardise clinical practice and optimise patient safety.
Drug Allergy Management
Untreated or poorly managed allergic diseases result in preventable morbidity and unnecessary doctor visits and hospital admissions. Optimal clinical care is essential for the diagnosis and management of allergic diseases and to ensure optimal patient outcomes.
There are several issues regarding drug allergy, particularly antibiotic allergy, that require urgent attention which will improve patient outcomes, reduce waiting times for more timely access to see an allergy specialist for individuals with more complex diagnosis or management and reduce the use of more expensive antibiotics instead of relatively inexpensive first tier antibiotics.
The National Allergy Strategy (NAS) has identified the following requirements for appropriate management of drug allergy:
- Effective drug allergy alert processes to prevent drug allergy deaths in hospitals are urgently required.
- Appropriate allergy testing and drug avoidance protocols to reduce unnecessary avoidance of penicillin group of antibiotics which will decrease the use of more expensive antibiotics.
- Management of patients with drug allergy in Australia is suboptimal due to the lack of standardisation of management, including clinical documentation. This highlights an urgent need for better educational support for primary and secondary healthcare practitioners treating patients with drug allergy.
- Data on the prevalence and clinical impact of drug allergy in Australia are sparse and national documentation of drug allergy may inform future management policies.
- A significant number of patients are referred to clinical immunology/allergy specialists when, with the right guidance, can be managed at primary or secondary care level.
- A national registry or drug allergy database, for patients with confirmed drug allergy will allow for a comprehensive collection of health information in regards to these cases. This data is critical to understand the extent of drug allergy in Australia, compare state and Australian data with overseas registries and deliver information for future national strategies for optimal management of drug allergy.
The government funding will enable the scoping of drug allergy issues occurring within hospitals as well as identify areas of need regarding education for health professionals.
Content updated April 2020