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From the President

Dear Colleagues,

According to the Centers for Disease Control and Prevention (CDC), each year at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States alone. One of the contributing factors to this growing health threat is the population of patients who report having a penicillin allergy but have not had the appropriate testing performed to confirm such an allergy. Published research has shown that without testing, an unverified history of penicillin allergy can contribute to longer hospitalizations, higher costs, greater risk for adverse effects of alternative (non-beta lactam) antibiotics, and increased rates of serious antibiotic-resistant infections.

Taking into account that as many as nine of 10 patients who are tested do not have an allergy to penicillin, you can understand why the AAAAI has identified verifying patient reported penicillin allergy as an important contribution in combating the ongoing emergence of antibiotic resistance. Your Board of Directors turned to the AAAAI’s Penicillin Allergy and Antibiotic Resistance Work Group to develop a draft position statement addressing the topic. This work group includes David M. Lang, MD, FAAAAI, lead author, Mariana C. Castells, MD, PhD, FAAAAI, David A. Khan, MD, FAAAAI, Eric M. Macy, MD, FAAAAI, and Andrew W. Murphy, MD, FAAAAI. To provide some additional perspective, I invited Drs. Lang and Castells to speak to the significance of the penicillin allergy position statement.

As lead author, David Lang noted: “This is the first position statement the AAAAI has released in almost a decade. Our work group believes passionately in the importance of providing care based on best evidence to patients with a history of penicillin allergy, and also in the importance of communicating the justification for penicillin allergy skin testing to healthcare providers and to the patients whom we have the privilege to serve. As AAAAI members are well aware, there is a morbidity associated with the label of ‘penicillin allergy’ that until recently has been unmeasured and underappreciated. At a time when value-based reimbursement is on the horizon, we can make a difference by performing penicillin allergy skin testing in properly selected patients. The evidence described in this position statement supports the contention that penicillin allergy skin testing will lead to improved healthcare outcomes, and will bring value to our patients and to the healthcare system.”

Mariana Castells added: “Penicillin and antibiotic allergies are commonly reported in the general population and yet the benefit of verifying these allergies is underestimated by most medical specialties. A mandate for the routine evaluation by allergists of all antibiotic and penicillin allergic patients should be provided to medical specialties. Several studies have provided strong evidence that patients labeled with penicillin allergy receive more expensive medications, have prolonged hospitalizations and are prone to more complications. Further, using second line medications to treat infections can promote the surge of antibiotic resistant bacteria. Appropriately labeling antibiotic allergic patients would enhance patients’ quality of care, safety and comfort at times of serious medical and surgical events. Treating non-allergic patients with the appropriate antibiotic will improve the response to infections, reduce health costs, and reduce complications. In addition, those truly allergic patients can be treated with penicillin and other antibiotics through desensitization, a groundbreaking procedure provided by allergists, which allows patients to use first line therapy.”

My thanks go to David, Mariana and their co-authors for contributing to this important discussion. The draft penicillin allergy position statement, currently out for member comment, is part of a larger advocacy effort by the AAAAI that includes ongoing engagement with the Stakeholders for Antibiotic Resistance Coalition (S-FAR), the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, participation in development of the National Quality Forum (NQF) Antibiotic Stewardship Playbook, and other activities.

AAAAI is a member organization of S-FAR, which is a national partnership convened by the Infectious Diseases Society of America. Its goal is to ensure that any U.S. government strategy to address antimicrobial resistance involves sustained and meaningful engagement with non-government experts and stakeholders throughout the policy development and implementation process. In addition, the AAAAI has attended and been represented at meetings of the Presidential Advisory Council. You can find more about the Advisory Council here.

Consistent with one of with my presidential initiatives, the AAAAI also advocates for expanding the scope of A/I practice, particularly in areas where public health is potentially significantly impacted, such as our call to increase the use of penicillin allergy testing to mitigate the emergence and spread of antibiotic resistance. In light of this, I urge all members to review and submit comments on the AAAAI’s draft penicillin allergy position statement by the September 6 deadline. You can find the draft here. I also encourage you to utilize the following resources that may be useful in your practice or institution:

Our specialty has a clear role to play in combating antibiotic resistance. Through our advocacy efforts, the AAAAI will continue to encourage penicillin allergy testing to reduce the large number of patients mislabeled as allergic to penicillin.

Sincerely,

Thomas A. Fleisher, MD, FAAAAI

AAAAI President

Last updated: August 11, 2016