Implementation and Impact of a ß-Lactam Allergy Assessment Protocol in a Veteran Population.

BACKGROUND: Approximately 10% of the US population reports having a ß-lactam allergy, although nearly 90% do not have a true immunoglobulin E (IgE)-mediated reaction. This misconception results in using nonpreferred antibiotics, leading to antimicrobial resistance and treatment failure. To evaluate, clarify, and clear ß-lactam allergies, we implemented a pharmacist-driven ß-lactam allergy assessment (BLAA) protocol and penicillin allergy clinic (PAC). The purpose of this study was to illustrate the BLAA process, including the pharmacist-run PAC, and assess the impact on allergy clearance. METHODS: Clinical pharmacy specialists (CPS) evaluated hospitalized veterans with ß-lactam allergies, using the BLAA protocol. Eligible patients could later be seen in PAC. This was a retrospective observational review of the BLAA protocol to assess recommendations for ß-lactam antibiotic use and PAC outcomes. RESULTS: Between November 2017 and February 2020, 278 patients were evaluated, and 32 were seen in the clinic. The most common allergen was penicillin, and the most reported reaction was a rash (27%) or pruritus and urticaria (18%). Through PAC and the BLAA protocol, 86 patients (31%) were cleared for allergy removal, and 188 (68%) were cleared for alternative ß-lactams. The evaluation revealed that 274 patients (99%) were eligible to receive a ß-lactam antibiotic, and only 4 patients (1%) were recommended for avoidance of all ß-lactams. CONCLUSIONS: These findings highlight the utility of the pharmacist-driven BLAA protocol. We illustrated that most patients with documented ß-lactam allergies were eligible for alternative ß-lactams. The implementation of the BLAA protocol and pharmacist-run PAC facilitated allergy clearance and has the potential to promote alternative ß-lactam use.

Impact of ß-Lactam Allergies on Antimicrobial Selection in an Outpatient Setting.

OBJECTIVE: The primary objective of this study was to determine whether patients prescribed nonpreferred antibiotics received appropriate alternative antibiotics. METHODS: This was a retrospective observational analysis of military veteran patients with a ß-lactam allergy treated in an outpatient clinic or emergency department for an infection during a 5-year span. Antibiotic regimens were first stratified as preferred or nonpreferred based on infection-specific guidelines. The nonpreferred regimens were then evaluated for appropriateness based on allergy history and culture and sensitivity reports. RESULTS: Of 445 fills of antibiotics evaluated, 269 met inclusion criteria, comprising 253 unique infections in 80 patients. Patients received nonpreferred antibiotics for their infection type in 57% of cases. Of the nonpreferred antibiotics, 56% were inappropriate based on guideline-recommended alternatives, allergy history, and culture and sensitivity data. Of the 88 allergies, 97% were historical/self-reported and 48% were cutaneous. In addition, 39% of patients safely received ß-lactam antibiotics after documentation of their allergy. CONCLUSIONS: Patients with documented ß-lactam allergies are at high risk of receiving nonpreferred and inappropriate antibiotics, and many reactions likely do not reflect true allergies. These data emphasize the negative impact of the "ß-lactam allergy" label and the importance of reassessing allergies.

Explicitly teaching English through the air to students who are deaf or hard of hearing.

The effects of the Language for Learning curriculum (Engelmann & Osborne, 1999) on through-the-air (i.e., signed and/or spoken) English skills for students who are deaf or hard of hearing (DHH) were examined by means of a single-subject, concurrent-multiple-probes-across-participants design. Four 11-year-old participants varied in auditory access, IQ, and age at amplification and/or cochlear implantation. All students showed increased accuracy of through-the-air English skills after the intervention (i.e., 15-20 lessons) and maintained these skills when assessed 1 week and 1 month later. The findings yielded some promising results indicating that a Direct Instruction curriculum may be an efficacious way to teach morphology and syntax to DHH students.

Deaf and hard of hearing students' through-the-air english skills: a review of formal assessments.

Strong correlations exist between signed and/or spoken English and the literacy skills of deaf and hard of hearing students. Assessments that are both valid and reliable are key for researchers and practitioners investigating the signed and/or spoken English skills of signing populations. The authors conducted a literature review to explore which tests researchers are currently using, how they administer the tests, and how reliability and validity are maintained. It was found that, overall, researchers working with this population use the same tests of English employed by practitioners working with hearing students (i.e., the Peabody Picture Vocabulary Test, Expressive One-Word Picture Vocabulary Test, and Clinical Evaluation of Language Fundamentals). There is a disconnect between what is being used in research with deaf and hard of hearing students and what is being used in practice with them. Implications for practice are discussed.