Hospitals develop app to weed out most inaccurate antibiotic allergies
Victorian hospitals are rallying behind a new diagnostic study that looks to take antibiotic allergy testing from surgical tables to smartphones.
Victorian Hospitals are road-testing an app to determine the risk of antibiotic allergies based on quick surveys that could disprove millions of false diagnoses and prevent the prescription of less-effective treatments ahead of surgeries.
The diagnostic app was developed by the Austin Hospital and tested on-site there and at the Alfred and Royal Melbourne Hospital after both Austin Health and the Lancet found more than 90 per cent of reported antibiotic allergies were inaccurate.
Misdiagnosis and false reporting by patients leads hospitals to push a significant portion of pre-surgery patients away from penicillin during treatment onto second-line antibiotics, given 20 per cent of patients report having an antibiotic allergy, of which half report a specific penicillin allergy.
Second-line antibiotic use raises infection risk and drives up the prevalence of antibiotic resistant bacteria.
Austin Health’s study, the Perioperative Penicillin and Cephalosporin Antibiotic Allergy Assessment and Testing (PREPARE) trial, compared the outcomes from clinicians who used traditional diagnostic methods with those who used the app as a precursor to other tests. Results indicated it provided a determination based on self-reported survey answers within a five minute average while maintaining safety and efficacy and reducing second-line prescription.
Study lead Jason Trubiano said the service would open up the workforce who could effectively test for allergies from dedicated allergists to more doctors, namely anaesthetists involved in deciding the antibiotic prescription of surgery patients.
After the app guided a consulting doctor through the assessment it provided a risk rating for whether a small test dose could be used to check for allergic reactions, or whether the patient should be triaged onto dedicated allergist skin tests.
Professor Trubiano said stamping out incorrect diagnoses was one part of winding back the “cavalier” prescription practices that had driven the worldwide threat of antibiotic resistant superbugs.
“We’ve got a lot of good systems where we remove or reduce inappropriate prescribing and I think addressing antibiotic allergies has become a novel way of fighting resistance,” Professor Trubiano said.
“Second-line antibiotics mean second-rate care — this research helps ensure surgical patients get the best treatment from the start.
“With this breakthrough, we can give more than 95 per cent of patients lifesaving antibiotics they didn’t know they could have.”
He called the trial a “revolution” in pre-surgery care.
“It was designed to enable people that don’t do antibiotic allergy tests in their day-to-day work to be able to assess somebody that has a reported penicillin allergy and find out if it’s likely to be false,” he said.
“This is taking what’s considered a complex thing to do and making it incredibly easy to do … The clinicians will ask the patient the question directed by the app. Like, do you have a penicillin allergy? Was it more than five years ago? Was it a rash? If the answers are yes, yes and yes then it’s likely to be low risk.
Side-effects of antibiotics and unrelated infant health issues mistaken for allergy symptoms commonly lead parents to mistakenly seek, or proclaim, their child’s diagnosis. When paired with poor historic understandings among doctors of how allergies develop over a lifetime, it has left two million Australians reporting allergies, of which a vast majority would likely be false.
“We want to see this – in the future – in the community,” Professor Trubiano said. “We’d love to see this move to general practice, because by and large penicillin allergies are reported there in the community; it doesn’t sit in hospitals.
“There’s been a re-education of the medical workforce and one of those things is knowing allergies can be lost over time.”
What you need to know
What is the purpose of antibiotics such as penicillin?
Penicillin is the first true antibiotic and is used, alongside countless subsequent medicines, to treat bacterial infections and prevent surgical wounds from becoming infected. Broadly, antibiotics empower the body’s own immune system in staving off disease.
Why are some people allergic to antibiotics?
Antibiotic allergies are largely random and occur when the body mistakenly produces antibodies to attack antibiotics entering the body. In the process this aggravates other immune processes and releases histamine, with reactions ranging in severity.
How can you test if a diagnosed allergy is correct?
Classically, skin prick tests are used to check if a patient reacts negatively to antibiotic exposure across multiple dosages. If the small exposure causes skin irritation, it suggests an allergic reaction. This can be followed up with oral dosing to monitor reactions.
The Austin Health study sought to streamline this process by predicting likely test results and directing low-risk patients towards the final testing steps, rather than directing them through the entire test process.
What are the symptoms of an antibiotic allergy?
Itchy skin, rashes, swelling and hives are the most common side effects of antibiotic allergies, along with coughing and short breath, though these can also be non-allergic effects of some antibiotics.
For those with antibiotic anaphylaxis, exposure risks fatal effects such as seizures, heart arrhythmias, fainting, and blood pressure drops.
Allergies can also cause cramping, diarrhoea, nausea and vomiting.
How common are antibiotic allergies and how many are real?
International studies place antibiotic allergy prevalence at an average of around 20 to 25 per cent of people, though with 90 to 95 per cent of those cases likely being inaccurate, or disappearing over a lifetime. In the cases that are accurate, anaphylaxis is exceptionally rare, sitting at between one and four cases per 10,000 according to the Australasian Society of Clinical Immunology and Allergy.
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