Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study)

Jason A Trubiano, Rekha Pai Mangalore, Yi-Wei Baey, Duy Le, Linda V Graudins, Patrick GP Charles, Douglas F Johnson and Ar Kar Aung
Med J Aust 2016; 204 (7): 273. || doi: 10.5694/mja15.01329


Objectives: To determine the nature, prevalence and description accuracy of recorded antibiotic allergy labels (AALs) in a cohort of general medical inpatients, and to assess the feasibility of an oral antibiotic re-challenge study.

Design: Multicentre cross-sectional study.

Setting and participants: All patients admitted to the general medical units of Austin Health and Alfred Health, 18 May – 5 June 2015.

Main outcome measures: Baseline demographics, medical and allergy history, infection diagnoses and antibiotic prescribing data for general medical inpatients were collected. A questionnaire was administered to clarify AAL history, followed by correlation of responses with electronic and admissions record descriptions. A hypothetical oral re-challenge in a supervised setting was offered to patients with low risk allergy phenotypes (non-immediate reaction, non-severe cutaneous adverse reaction, or unknown reaction more than 10 years ago).

Results: Of the 453 inpatients, 107 (24%) had an AAL (median age, 82 years; interquartile range, 74–87 years); 160 individual AALs were recorded, and there was a mismatch in AAL description between recording platforms in 25% of cases. Most patients with an AAL were women (64%; P < 0.001), and more presented with concurrent immunosuppression than those without an AAL (23% v 8%; P < 0.001). β-Lactam penicillins were employed less frequently in patients with an AAL (16% v 35%; P = 0.02), while ceftriaxone (32% v 20%; P = 0.02) and fluoroquinolones (6% v 2%; P = 0.04) were used more often. Fifty-four per cent of patients with AALs were willing to undergo oral re-challenge, of whom 48% had a low risk allergy phenotype.

Conclusions: AAL prevalence in general medical inpatients was 24%, and was associated with excessive use of broad spectrum antibiotics. Allergies in a large proportion of patients with AALs were incorrectly documented, and were non-immune-mediated and potentially amenable to oral re-challenge. A direct oral re-challenge study in carefully selected patients with low risk allergy phenotypes appears feasible.

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  • Jason A Trubiano1,2
  • Rekha Pai Mangalore1
  • Yi-Wei Baey3
  • Duy Le1
  • Linda V Graudins4
  • Patrick GP Charles1
  • Douglas F Johnson1
  • Ar Kar Aung4

  • 1 Austin Health, Melbourne, VIC
  • 2 University of Melbourne, Parkville, VIC
  • 3 Monash Medical Centre, Melbourne, VIC
  • 4 Alfred Health, Melbourne, VIC

Competing interests:

No relevant disclosures.

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