User login
Allergists must standardize penicillin allergy patient testing, advice, and labeling
HOUSTON – What is the most reliable test for determining whether a patient has outgrown a penicillin allergy? Allergists’ preferences vary widely, judging from findings of an e-mail survey presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The investigators polled 652 AAAAI-member allergists to determine how practitioners were evaluating and either labeling or unlabeling patients with suspected penicillin allergy.
“The majority of patients outgrow penicillin allergies within 5 years – over 80% – so the problem becomes what’s the best way of removing that label from their charts,” explained Dr. Kali Gerace of Vanderbilt University, Nashville, Tenn., in an interview. “Among allergy providers, the practice is variable partly [because] of availability of the reagents; for example, Pre-Pen is on the market for anyone who wants to get it, but MDM (minor determinant mixture) is not commercially available, and therefore you can only test to it if your institution makes it.”
AAAAI allergists reported that they most often used Pre-Pen, penicillin G, and MDM as their preferred form of skin-prick or intradermal testing. Of these, penicillin G was used more than MDM by a ratio of 75.2% to 38.3%. On the other hand, academic practices were more likely to use MDM, with 44% reporting their preference for MDM while only 36% of all other practitioners responded similarly (P = .09). Allergists in practice for less than 10 years were more likely to prefer oral challenge testing to assess penicillin allergy, with 93% responding as such, compared with 85% of the rest of allergists surveyed (P = .01).
Of practices performing both skin-prick testing and oral challenge, 163 (35.7%) said they advised patients to take all penicillins and cephalosporins; 120 (26.3%) advised patients to only take the drugs that they safely passed the oral challenge with. Seventy-four (16.2%) respondents said they advised patients to take a beta-lactam only if the benefit outweighed the risk, 40 (8.8%) said they advise taking only penicillins or cephalosporins with negative testing, 15 (3.3%) said they do not offer any recommendations and prefer leaving it up to patients and primary care providers to determine the best course of action, and 45 (9.8%) reported following “other” protocols.
Practices that reported using only skin testing did not have significantly different rates from those offering no recommendations and those reporting “other” protocols: 3 (4.9%) and 5 (8.2%), respectively. However, 13 (21.3%) advised patients to take all penicillins and cephalosporins, while 20 (32.8%) advised taking only those medications for which the patient tested negative, 4 (6.6%) recommended taking antibiotics to which the patients showed no allergy on oral challenge, and 18 (29.5%) recommended beta-lactams in certain situations.
Overall, 72% of those surveyed said that they preferred using skin-prick testing and oral challenge to determine penicillin allergy, compared with 18% who preferred skin-prick testing alone. Oral challenge alone was reported by 4% of those surveyed, and 6% reported “no testing available.” Private practices accounted for 62.3% of those surveyed, with academic practices making up 26.2% of the population, managed care comprising 5.2%, and combination practices the remaining 3.7%.
“As allergy providers, we can achieve standardization by revising our practice parameters and making them more specific to the best method for testing,” said Dr. Gerace. “We need to find the most cost-effective way of dealing with [these] patients and finding a way to standardize the advice we give them as providers.”
Dr. Gerace did not report any relevant financial disclosures.
HOUSTON – What is the most reliable test for determining whether a patient has outgrown a penicillin allergy? Allergists’ preferences vary widely, judging from findings of an e-mail survey presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The investigators polled 652 AAAAI-member allergists to determine how practitioners were evaluating and either labeling or unlabeling patients with suspected penicillin allergy.
“The majority of patients outgrow penicillin allergies within 5 years – over 80% – so the problem becomes what’s the best way of removing that label from their charts,” explained Dr. Kali Gerace of Vanderbilt University, Nashville, Tenn., in an interview. “Among allergy providers, the practice is variable partly [because] of availability of the reagents; for example, Pre-Pen is on the market for anyone who wants to get it, but MDM (minor determinant mixture) is not commercially available, and therefore you can only test to it if your institution makes it.”
AAAAI allergists reported that they most often used Pre-Pen, penicillin G, and MDM as their preferred form of skin-prick or intradermal testing. Of these, penicillin G was used more than MDM by a ratio of 75.2% to 38.3%. On the other hand, academic practices were more likely to use MDM, with 44% reporting their preference for MDM while only 36% of all other practitioners responded similarly (P = .09). Allergists in practice for less than 10 years were more likely to prefer oral challenge testing to assess penicillin allergy, with 93% responding as such, compared with 85% of the rest of allergists surveyed (P = .01).
Of practices performing both skin-prick testing and oral challenge, 163 (35.7%) said they advised patients to take all penicillins and cephalosporins; 120 (26.3%) advised patients to only take the drugs that they safely passed the oral challenge with. Seventy-four (16.2%) respondents said they advised patients to take a beta-lactam only if the benefit outweighed the risk, 40 (8.8%) said they advise taking only penicillins or cephalosporins with negative testing, 15 (3.3%) said they do not offer any recommendations and prefer leaving it up to patients and primary care providers to determine the best course of action, and 45 (9.8%) reported following “other” protocols.
Practices that reported using only skin testing did not have significantly different rates from those offering no recommendations and those reporting “other” protocols: 3 (4.9%) and 5 (8.2%), respectively. However, 13 (21.3%) advised patients to take all penicillins and cephalosporins, while 20 (32.8%) advised taking only those medications for which the patient tested negative, 4 (6.6%) recommended taking antibiotics to which the patients showed no allergy on oral challenge, and 18 (29.5%) recommended beta-lactams in certain situations.
Overall, 72% of those surveyed said that they preferred using skin-prick testing and oral challenge to determine penicillin allergy, compared with 18% who preferred skin-prick testing alone. Oral challenge alone was reported by 4% of those surveyed, and 6% reported “no testing available.” Private practices accounted for 62.3% of those surveyed, with academic practices making up 26.2% of the population, managed care comprising 5.2%, and combination practices the remaining 3.7%.
“As allergy providers, we can achieve standardization by revising our practice parameters and making them more specific to the best method for testing,” said Dr. Gerace. “We need to find the most cost-effective way of dealing with [these] patients and finding a way to standardize the advice we give them as providers.”
Dr. Gerace did not report any relevant financial disclosures.
HOUSTON – What is the most reliable test for determining whether a patient has outgrown a penicillin allergy? Allergists’ preferences vary widely, judging from findings of an e-mail survey presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The investigators polled 652 AAAAI-member allergists to determine how practitioners were evaluating and either labeling or unlabeling patients with suspected penicillin allergy.
“The majority of patients outgrow penicillin allergies within 5 years – over 80% – so the problem becomes what’s the best way of removing that label from their charts,” explained Dr. Kali Gerace of Vanderbilt University, Nashville, Tenn., in an interview. “Among allergy providers, the practice is variable partly [because] of availability of the reagents; for example, Pre-Pen is on the market for anyone who wants to get it, but MDM (minor determinant mixture) is not commercially available, and therefore you can only test to it if your institution makes it.”
AAAAI allergists reported that they most often used Pre-Pen, penicillin G, and MDM as their preferred form of skin-prick or intradermal testing. Of these, penicillin G was used more than MDM by a ratio of 75.2% to 38.3%. On the other hand, academic practices were more likely to use MDM, with 44% reporting their preference for MDM while only 36% of all other practitioners responded similarly (P = .09). Allergists in practice for less than 10 years were more likely to prefer oral challenge testing to assess penicillin allergy, with 93% responding as such, compared with 85% of the rest of allergists surveyed (P = .01).
Of practices performing both skin-prick testing and oral challenge, 163 (35.7%) said they advised patients to take all penicillins and cephalosporins; 120 (26.3%) advised patients to only take the drugs that they safely passed the oral challenge with. Seventy-four (16.2%) respondents said they advised patients to take a beta-lactam only if the benefit outweighed the risk, 40 (8.8%) said they advise taking only penicillins or cephalosporins with negative testing, 15 (3.3%) said they do not offer any recommendations and prefer leaving it up to patients and primary care providers to determine the best course of action, and 45 (9.8%) reported following “other” protocols.
Practices that reported using only skin testing did not have significantly different rates from those offering no recommendations and those reporting “other” protocols: 3 (4.9%) and 5 (8.2%), respectively. However, 13 (21.3%) advised patients to take all penicillins and cephalosporins, while 20 (32.8%) advised taking only those medications for which the patient tested negative, 4 (6.6%) recommended taking antibiotics to which the patients showed no allergy on oral challenge, and 18 (29.5%) recommended beta-lactams in certain situations.
Overall, 72% of those surveyed said that they preferred using skin-prick testing and oral challenge to determine penicillin allergy, compared with 18% who preferred skin-prick testing alone. Oral challenge alone was reported by 4% of those surveyed, and 6% reported “no testing available.” Private practices accounted for 62.3% of those surveyed, with academic practices making up 26.2% of the population, managed care comprising 5.2%, and combination practices the remaining 3.7%.
“As allergy providers, we can achieve standardization by revising our practice parameters and making them more specific to the best method for testing,” said Dr. Gerace. “We need to find the most cost-effective way of dealing with [these] patients and finding a way to standardize the advice we give them as providers.”
Dr. Gerace did not report any relevant financial disclosures.
Key clinical point: There is urgent need to standardize effective testing and reporting methods regarding patients with penicillin allergy.
Major finding: 15% of AAAAI-member allergists surveyed reported a wide range of techniques and advising protocols for patients with penicillin allergy, raising the alarm for standardization sooner rather than later.
Data source: An e-mail survey of 652 AAAAI-member allergists.
Disclosures: Dr. Gerace reported no relevant financial disclosures.
Look for adverse events in patients with chronic urticaria
HOUSTON – The risk of adverse events may be cumulative over the lifetime of patients taking oral corticosteroids for urticaria.
Dr. Dennis Ledford, professor of medicine at the University of South Florida, Tampa, and his colleagues examined records of 12,647 patients culled from a commercial claims database between January 2008 and December 2012 who had taken oral corticosteroids for chronic idiopathic or spontaneous urticaria during a 12-month period. More than half (55%) used oral corticosteroids (mean dosage of 367.5 mg) for an average of 16.2 days. At follow-up, patients displayed adverse events at a rate of 27 per 100 patient-years.
Adverse events mostly included skeletal conditions such as osteoporosis and bone fractures, but investigators also noted diabetes, hypertension, lipid disorders, depression, mania, and cataracts, Dr. Ledford said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
More concerning, “there’s a cumulative risk,” Dr. Ledford said in an interview. “The more [prednisone equivalent] you take over your lifetime, the greater the chance is that you’re going to develop the side effects we’ve listed here.”
Using time-sensitive Cox regression models, Dr. Ledford and his colleagues determined that the risk for adverse events went up by 7% for each gram dose of prednisone equivalent to which patients were exposed after adjusting for age, sex, immunomodulator use, and Charlson Comorbidity Index. Only cataracts were not subject to the cumulative effects.
“The message of this fairly large analysis is that there are cumulative side effects to prednisone that may not be evident to the physician or clinician performing day-to-day care of patients,” Dr. Ledford said. “These effects are slow to develop and often present in areas of medicine that the physician treating urticaria would not take care of.”
Patients enrolled in this study had all been diagnosed with urticaria at either of two outpatient clinic visits at least 6 weeks apart in a single calendar year, or had received one diagnosis of urticaria and one of angioedema at two separate outpatient clinics at least 6 weeks apart. Patients were followed for at least 1 year after completion of the initial 12-month study period, until end of enrollment or end of study.
Dr. Ledford stressed the need to use noncorticosteroid therapies when treating chronic urticaria, such as calcineurin inhibitors – which also carry risks of hypertension and cancer – or omalizumab.
The study was funded by Genentech and Novartis Pharma AG which market omalizumab as Xolair. Dr. Ledford disclosed that he is affiliated with Genentech, Novartis Pharma AG, and a number of other pharmaceutical companies.
HOUSTON – The risk of adverse events may be cumulative over the lifetime of patients taking oral corticosteroids for urticaria.
Dr. Dennis Ledford, professor of medicine at the University of South Florida, Tampa, and his colleagues examined records of 12,647 patients culled from a commercial claims database between January 2008 and December 2012 who had taken oral corticosteroids for chronic idiopathic or spontaneous urticaria during a 12-month period. More than half (55%) used oral corticosteroids (mean dosage of 367.5 mg) for an average of 16.2 days. At follow-up, patients displayed adverse events at a rate of 27 per 100 patient-years.
Adverse events mostly included skeletal conditions such as osteoporosis and bone fractures, but investigators also noted diabetes, hypertension, lipid disorders, depression, mania, and cataracts, Dr. Ledford said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
More concerning, “there’s a cumulative risk,” Dr. Ledford said in an interview. “The more [prednisone equivalent] you take over your lifetime, the greater the chance is that you’re going to develop the side effects we’ve listed here.”
Using time-sensitive Cox regression models, Dr. Ledford and his colleagues determined that the risk for adverse events went up by 7% for each gram dose of prednisone equivalent to which patients were exposed after adjusting for age, sex, immunomodulator use, and Charlson Comorbidity Index. Only cataracts were not subject to the cumulative effects.
“The message of this fairly large analysis is that there are cumulative side effects to prednisone that may not be evident to the physician or clinician performing day-to-day care of patients,” Dr. Ledford said. “These effects are slow to develop and often present in areas of medicine that the physician treating urticaria would not take care of.”
Patients enrolled in this study had all been diagnosed with urticaria at either of two outpatient clinic visits at least 6 weeks apart in a single calendar year, or had received one diagnosis of urticaria and one of angioedema at two separate outpatient clinics at least 6 weeks apart. Patients were followed for at least 1 year after completion of the initial 12-month study period, until end of enrollment or end of study.
Dr. Ledford stressed the need to use noncorticosteroid therapies when treating chronic urticaria, such as calcineurin inhibitors – which also carry risks of hypertension and cancer – or omalizumab.
The study was funded by Genentech and Novartis Pharma AG which market omalizumab as Xolair. Dr. Ledford disclosed that he is affiliated with Genentech, Novartis Pharma AG, and a number of other pharmaceutical companies.
HOUSTON – The risk of adverse events may be cumulative over the lifetime of patients taking oral corticosteroids for urticaria.
Dr. Dennis Ledford, professor of medicine at the University of South Florida, Tampa, and his colleagues examined records of 12,647 patients culled from a commercial claims database between January 2008 and December 2012 who had taken oral corticosteroids for chronic idiopathic or spontaneous urticaria during a 12-month period. More than half (55%) used oral corticosteroids (mean dosage of 367.5 mg) for an average of 16.2 days. At follow-up, patients displayed adverse events at a rate of 27 per 100 patient-years.
Adverse events mostly included skeletal conditions such as osteoporosis and bone fractures, but investigators also noted diabetes, hypertension, lipid disorders, depression, mania, and cataracts, Dr. Ledford said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
More concerning, “there’s a cumulative risk,” Dr. Ledford said in an interview. “The more [prednisone equivalent] you take over your lifetime, the greater the chance is that you’re going to develop the side effects we’ve listed here.”
Using time-sensitive Cox regression models, Dr. Ledford and his colleagues determined that the risk for adverse events went up by 7% for each gram dose of prednisone equivalent to which patients were exposed after adjusting for age, sex, immunomodulator use, and Charlson Comorbidity Index. Only cataracts were not subject to the cumulative effects.
“The message of this fairly large analysis is that there are cumulative side effects to prednisone that may not be evident to the physician or clinician performing day-to-day care of patients,” Dr. Ledford said. “These effects are slow to develop and often present in areas of medicine that the physician treating urticaria would not take care of.”
Patients enrolled in this study had all been diagnosed with urticaria at either of two outpatient clinic visits at least 6 weeks apart in a single calendar year, or had received one diagnosis of urticaria and one of angioedema at two separate outpatient clinics at least 6 weeks apart. Patients were followed for at least 1 year after completion of the initial 12-month study period, until end of enrollment or end of study.
Dr. Ledford stressed the need to use noncorticosteroid therapies when treating chronic urticaria, such as calcineurin inhibitors – which also carry risks of hypertension and cancer – or omalizumab.
The study was funded by Genentech and Novartis Pharma AG which market omalizumab as Xolair. Dr. Ledford disclosed that he is affiliated with Genentech, Novartis Pharma AG, and a number of other pharmaceutical companies.
AT 2015 AAAAI ANNUAL MEETING
Key clinical point: The cumulative adverse events of oral corticosteroids may not present to the physician treating the patient for urticaria.
Major finding: The risk for adverse events went up by 7% for each gram dose of prednisone equivalent.
Data source: Retrospective cohort study of 12,647 patients selected from a commercial claims database from 2008 through 2012.
Disclosures: Study funded by Genentech and Novartis Pharma AG; Dr. Ledford is affiliated with Genentech, Novartis Pharma AG, and a number of other pharmaceutical companies.
