Dr Jason Trubiano
Mrs Wendy Stevenson
Mrs Rebecca Hall
Dr Natasha Holmes
Dr Ian Leston/Dr Chris Fiddes (Anaesthetics)
Antimicrobial Stewardship Pharmacist:
Ms Misha Devchand
Phone: (03) 9496 6676
Fax: (03) 9496 6677
Introduction to the Drug and Antibiotic Allergy Service
The Drug and Antibiotic Allergy Services (DAAS) at Austin Health comprises a multidisciplinary team addressing patient-reported drug and antibiotic allergies. This service incorporates the Infectious Diseases Antibiotic Allergy Clinic (IDAC), perioperative antibiotic allergy clinic (POAC), inpatient antibiotic allergy testing service, oral penicillin rechallenge program and telehealth. This is a novel service that provides comprehensive clinical assessment, skin testing and oral challenge to patients with a history of antibiotic allergy or severe adverse drug reactions. This is an important initiative as whilst 10-20% of the population are “labelled” as penicillin allergic, only 1-2% are positive on formal testing.
Aims of the Drug and Antibiotic Allergy Service
The primary aim of the service is to ensure patients are correctly “labelled” as allergic, to enable the safe and appropriate administration of antibiotics and other medicines. This is paramount especially in those that require ongoing or frequent antibiotic therapy that is being hampered by a current antibiotic allergy. In addition, the provision of safe anaesthesia often requires careful perioperative allergy assessment in those with a previous anaesthetic adverse drug reaction. The clinical service specializes in the provision of clinical testing for patients with a history of severe T-cell mediated adverse drug reaction (e.g. Stevens-Johnson syndrome [SJS], drug reaction with eosinophilia and systemic symptoms [DRESS]).
Links with Antibiotic Allergy Research
The Drug and Antibiotic Allergy Service works in collaboration with the Centre for Antibiotic Allergy and Research (CAAR). CAAR is based at Austin Health and collaborates with several centres locally and internationally to better understand the reasons why patients have such severe reactions and to develop better antibiotic allergy diagnostics. CAAR is focused on developing clinical programs that aid the removal (‘de-labelling’) of antibiotic allergies to improve antibiotic prescribing. The special interest of the Antibiotic Allergy Service and CAAR is patients with antibiotic associated severe cutaneous adverse reactions (e.g. SJS, Toxic Epidermal Necrolysis [TEN], DRESS), for which we offer novel laboratory T-cell diagnostics and testing.
Testing and Referral Process
The clinical assessment is undertaken over successive visits on referral from a medical specialist or general practitioner. Referrals are welcomed from other health services, for patients with frequent antibiotic or perioperative needs hindered by a drug allergy “label”. The clinic is run by Dr Jason Trubiano in collaboration with pharmacists, infectious diseases physicians, immunologists, allergists and anaesthetists. The clinic runs on a weekly basis, with perioperative drug testing occurring on a monthly rotation. Testing performed includes:
1. Skin prick and intradermal testing
2. Patch testing
3. Oral provocation (challenge) testing
Referrals can be made by completing the referral form and either:
1. Faxed - (03) 94966677; or
2. Emailed - firstname.lastname@example.org; or
3. Posted – Drug and Antibiotic Allergy Services, Dept. Infectious Diseases, Austin Health, PO BOX 5555 Heidelberg, VIC 3084
For further advice please contact our clinical nurse specialist or clinicians on (03) 94966676.
Recent publications from the research and clinical group are listed below:
1. Trubiano JA, Strautins K, Redwood AJ, Pavlos R, Konvinse KC, Aung AK, Slavin MA, Thursky KA, Grayson ML, Phillips EJ. The Combined Utility of Ex vivo IFN-γ Release Enzyme-Linked ImmunoSpot Assay and In vivo Skin Testing in Patients With Antibiotic-Associated Severe Cutaneous Adverse Reactions. J Allergy Clin Immunol Pract. 2017 Oct 31
2. Trubiano JA, Stone CA, Grayson ML, Urbancic K, Slavin MA, Thursky KA, Phillips EJ. The 3 Cs of Antibiotic Allergy-Classification, Cross-Reactivity, and Collaboration. J Allergy Clin Immunol Pract. 2017 Nov - Dec;5(6):1532-1542
3. Trubiano JA, Adkinson NF, Phillips EJ. Penicillin Allergy Is Not Necessarily Forever. JAMA. 2017 Jul 4;318(1):82-83
4. Trubiano JA, Thursky KA, Stewardson AJ, Urbancic K, Worth LJ, Jackson C, Stevenson W, Sutherland M, Slavin MA, Grayson ML, Phillips EJ. Impact of an Integrated Antibiotic Allergy Testing Program on Antimicrobial Stewardship: A Multicenter Evaluation. Clin Infect Dis. 2017 Jul 1;65(1):166-174.
5. Konvinse KC, Phillips EJ, White KD, Trubiano JA. Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity. Curr Opin Infect Dis. 2016 Dec;29(6):561-576.
6. Trubiano JA, Redwood A, Strautins K, Pavlos R, Woolnough E, Chang CC, Phillips E. Drug-specific upregulation of CD137 on CD8+ T cells aids in the diagnosis of multiple antibiotic toxic epidermal necrolysis. J Allergy Clin Immunol Pract. 2017 May - Jun;5(3):823-826
7. Trubiano JA, Aung AK, Nguyen M, Fehily SR, Graudins L, Cleland H, Padiglione A, Peleg AY. A Comparative Analysis Between Antibiotic- and Nonantibiotic-Associated Delayed Cutaneous Adverse Drug Reactions. J Allergy Clin Immunol Pract. 2016 Nov - Dec;4(6):1187-1193. doi: 10.1016/j.jaip.2016.04.026. Epub 2016 Jun 7.
8. Goldblatt C, Khumra S, Booth J, Urbancic K, Grayson ML, Trubiano JA. Poor reporting and documentation in drug-associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis - Lessons for medication safety. Br J Clin Pharmacol. 2017 Feb;83(2):224-226.
9. Trubiano JA, Chen C, Cheng AC, Grayson ML, Slavin MA, Thursky KA; National Antimicrobial Prescribing Survey (NAPS). Antimicrobial allergy 'labels' drive inappropriate antimicrobial prescribing: lessons for stewardship. J Antimicrob Chemother. 2016 Jun;71(6):1715-22.
10. Trubiano J, Phillips E. Antimicrobial stewardship's new weapon? A review of antibiotic allergy and pathways to 'de-labeling'. Curr Opin Infect Dis. 2013 Dec;26(6):526-37.