Oncologist Dr. Belinda Yeoh and a patient

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Calls for more allergy testing to restore patient access to first-line antibiotics

Calls for more allergy testing to restore patient access to first-line antibiotics

June 2018

Incorrect antibiotic allergy labels pose a significant public health issue and more needs to be done to ensure Australia's most vulnerable patients are not incorrectly diverted to second-line drugs.

In a perspective article published in the Medical Journal of Australia today, Dr Jason Trubiano says incorrect antibiotic allergy labels frequently prevent the use of appropriate narrow spectrum penicillin and targeted antibiotic therapies and often it is the sickest patients who suffer.

Dr Trubiano - who is Austin Health's Director of Antimicrobial Stewardship and Drug and Antibiotic Allergy Services, as well as an Infectious Diseases Specialist at Peter MacCallum Cancer Centre - established Victoria's first dedicated antibiotic allergy clinic which is now operating at both sites.

"This clinic is now routinely testing patients to find those with antibiotic allergies wrongly listed on their record, so this does not unnecessarily limit the treatments they can receive," says Dr Trubiano.

"By removing these incorrect antibiotic allergy labels we can restore patients' access to first-line and preferred antibiotics - and this reduces the risk of treatment failure, post-surgical infection and an extended hospital stay."

The over-application of antibiotic allergy labels also increases reliance on other widely-acting antibiotics which can promote the rise of antimicrobial resistance and superbugs.

Dr. Trubiano recently published a study of Austin Health and Peter Mac patients which showed most (83%) had an antibiotic allergy label that was incorrect and should be erased from their medical record. Almost half (48%) of these patients were immunocompromised, with many receiving treatment for cancer or post organ or stem cell transplant.

Antibiotic allergy labels may not be confirmed at the time they are listed on a patient's medical record. They can carry-over from a childhood rash where a viral cause was possible, or patients may lose sensitivity over the years effectively growing out of their antibiotic allergy.

Another recent study, also cited in the MJA article, found 81% of Australians who were listed as allergic to penicillin could have this label removed after testing.

"We are calling for more awareness - patients with lowered immune systems need to be aware that many antibiotic allergy labels can be removed and thus open up their window of antibiotic choices," Dr Trubiano says.

"We also need multidisciplinary centralised testing services like those on offer at Austin Health and the Peter Mac that focus on our vulnerable patients, as well as simple point-of-care allergy testing programs in each hospital to remove low risk and unlikely allergies."

The antibiotic allergy testing at Peter Mac and Austin Health involves a skin-prick challenge under supervision. Dr Trubiano and the team from the National Centre for Infections in Cancer (NCIC), which is based at Peter Mac, are also collaborating to develop novel blood tests and testing programs so that vulnerable patients suspected of having severe allergies can also be safely tested.

The NCIC is a platform to address the critical need for informed strategies to improve the surveillance, prevention and management of infections in patient with cancer in Australia.

About Peter Mac
Peter MacCallum Cancer Centre is one of the world's leading cancer research, education and treatment centres globally and is Australia's only public hospital solely dedicated to caring for people affected by cancer. We have over 2,500 staff, including more than 580 laboratory and clinical researchers, all focused on providing better treatments, better care and potential cures for cancer.

About Austin Health
Austin Health is a leading tertiary health service which is renowned for its specialist work in cancer, liver transplantation, spinal cord injuries, neurology, endocrinology, mental health and rehabilitation including a number of state-wide services. Austin Health is an internationally recognised leader in clinical teaching and training, affiliated with eight universities. It is the largest Victorian provider of training for specialist physicians and surgeons.