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UNDERSTANDING BARRIERS TO OUTPATIENT REFERRAL FOR PENICILLIN TESTING
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 121 (2018) S22−S62
P101
P103
SYSTEMIC REACTIONS TO SCIT: EFFECTS OF DOSING AND AEROALLERGEN CONTENT T. Bingemann, H. Blue, K. Conn, T. Hanley, A. Ramsey, S. Mustafa*, Rochester, NY
UNDERSTANDING BARRIERS TO OUTPATIENT REFERRAL FOR PENICILLIN TESTING E. Jones*, C. Le, A. Kim, San Diego, CA
Introduction: The aim of this study was to identify the dose of subcutaneous immunotherapy (SCIT) that caused the most systemic reactions (SCITSR), and identify any other risk factors for SCITSR. Methods: We performed a retrospective review of all SCIT encounters from 2013-2017 at a multi-site Allergy/Immunology practice. SCIT was administered in doses consistent with practice parameters. SCITSR were identified through immunotherapy encounters in which epinephrine was administered. Collected data included patient demographics, along with the dose of SCIT at time of the SR, the presence or absence of asthma, and aeroallergen content. The control group was generated randomly from the same cohort during the same time period. Results: There were 86,949 SCIT visits, with 81 SCITSR (0.9/1000). 77.8% of reactions occurred at dose of 1:1 0.1 ml and above. The presence of cat (81.5% vs. 63%, p=.014), dog (67.9% vs. 37.0%, p Conclusions: Risk factors for SCITSR in a multisite Allergy/Immunology practice included administration of the highest immunotherapy doses, inclusion of cat, dog, and grass extracts, and the number of aeroallergenic groups included in the extract. This information helps further characterize risk for patients receiving SCIT.
P102 PROSPECTIVE EFFICACY STUDY OF A SELF-ADMINISTERED ALLERGENIMMUNOTHERAPY PROTOCOL F. Schaffer*,1, T. Hulsey2, M. Ebeling3, W. Wagoner1, 1. San Antonio, TX; 2. Morgantown, WV; 3. Charleston, SC Introduction: We have previously demonstrated the safety of a selfadministered subcutaneous immunotherapy protocol (SCIT; IFAR 2015;5:149-156). Here we report the preliminary results of our IRB approved prospective efficacy study. Methods: Subjects that met the inclusion criteria and chose SCIT therapy constituted the treatment group (N=54). Those that deferred SCIT therapy constituted the control group (N=28). All patients were studied and were on therapy for a mean of 32 months. The study primary outcome measure was the combined symptom plus medication scores (SS+MS). The secondary outcome measure was the rhinoconjuctivitis quality of life (RQLQ) scores. Statistical assessment utilized the student and paired T-test. Results: The study groups were well matched as manifested by baseline measures that demonstrated no significant differences. Patient groups were compared based on common aeroallergen allergies, season, and relevant pollen counts. Treatment patient analyses showed significant improvement (41-56%) compared to baseline indices for SS, MS, SS+MS and RQLQ. In contrast, control group indices demonstrated little to no improvement. Treatment group results demonstrated improvements of 57% (57% (SS, p<0.0001), 36% (MS, p<0.02), 53% (SS+MS, p<0.0001), and 43% (RQLQ, p=0.0001) in comparison to control group indices. These improvements are clinically relevant based on the WAO criteria (Allergy 2007;62:317−324). Meta analyses demonstrated that our study outcomes are similar to those trials that assessed the efficacy of office-based SCIT administration. Conclusions: These results demonstrate that the self-administered SCIT protocol used in this study produced significant and clinically relevant improvement. When contrasted with office-based SCIT studies, our efficacy was found to be equivalent.
S27
Introduction: Penicillin allergy is the most common beta-lactam drug allergy and is estimated to affect approximately 10% of the population. Large-scale efforts are underway nationwide to test and verify documented penicillin allergy in order to promote antibiotic stewardship and improve public health. The purpose of this study is to determine barriers to outpatient referrals to allergy clinic for penicillin testing so that they may be appropriately addressed. Methods: Surveys were electronically distributed to primary care providers in order to assess providers’ perceptions of penicillin allergy and to determine barriers to referral to allergy clinic. Eligible subjects included attending and resident physicians in the Departments of Internal Medicine and Family Medicine. Results: A total of 204 subjects were invited to participate in the study. Eighty-five subjects (42%) completed the survey. Providers identified the following as the most significant barriers to allergy clinic referral: “Patients have multiple other medical problems which take priority in time-limited encounters” (41%), “I did not realize that this service was available for my patients” (26%), “I am concerned that the allergy history is inaccurate or unclear” (12%), “I don’t think my patients will follow through with the referral” (5%), and “Other” (16%). Conclusions: A number of knowledge and logistical gaps have been identified as barriers to outpatient referral for penicillin allergy testing and verification. Further study of techniques to overcome these barriers is warranted.
P104 MAXIMIZING OPPORTUNITIES FOR SKIN PRICK TESTING AT INITIAL ALLERGY CLINIC VISIT USING AN EDUCATIONAL BROCHURE A. Grippen Goddard*,1, B. Davis2, 1. Denver, CO; 2. Iowa City, IA Introduction: Many atopic patients present to allergy clinic taking medications that interfere with allergy skin prick testing (SPT) due to lack of communication amongst providers, clinics and patients. We investigated the effect of a mailed brochure on rates of allergy SPT at an initial clinic visit. Methods: A retrospective chart review was performed on new patients presenting to an Allergy/Immunology clinic from November 2016 to November 2017. An educational brochure describing the allergy SPT procedure and instructions for holding medications was mailed before the appointment. The effect of the intervention was analyzed via prospective chart review from November 2017 to May 2018. Research was exempt from IRB review. Results: We reviewed 96 charts pre-intervention and 79 charts postintervention that were appropriate for allergy SPT. The percentage of patients who were not taking interfering medications and successfully completed allergy SPT rose from 63% (n=60) prior to the intervention to 84% (66) after the intervention (p=0.002). Wait time for new patients decreased from three months to one week after the intervention. Of patients completing a post-intervention survey, 59% (47) reported they had received the brochure more than five days before the appointment. Steroid nasal sprays were held incorrectly by 12 patients, accounting for 86% of incorrectly held medications. Two (2%) adverse events occurred in association with the mailed brochure, namely an urticaria exacerbation and an episode of acute angioedema. Conclusions: Our results suggest that communicating with patients via a mailed brochure is an effective intervention to increase the number of successful allergy SPT’s during the initial visit.
P101
P103
SYSTEMIC REACTIONS TO SCIT: EFFECTS OF DOSING AND AEROALLERGEN CONTENT T. Bingemann, H. Blue, K. Conn, T. Hanley, A. Ramsey, S. Mustafa*, Rochester, NY
UNDERSTANDING BARRIERS TO OUTPATIENT REFERRAL FOR PENICILLIN TESTING E. Jones*, C. Le, A. Kim, San Diego, CA
Introduction: The aim of this study was to identify the dose of subcutaneous immunotherapy (SCIT) that caused the most systemic reactions (SCITSR), and identify any other risk factors for SCITSR. Methods: We performed a retrospective review of all SCIT encounters from 2013-2017 at a multi-site Allergy/Immunology practice. SCIT was administered in doses consistent with practice parameters. SCITSR were identified through immunotherapy encounters in which epinephrine was administered. Collected data included patient demographics, along with the dose of SCIT at time of the SR, the presence or absence of asthma, and aeroallergen content. The control group was generated randomly from the same cohort during the same time period. Results: There were 86,949 SCIT visits, with 81 SCITSR (0.9/1000). 77.8% of reactions occurred at dose of 1:1 0.1 ml and above. The presence of cat (81.5% vs. 63%, p=.014), dog (67.9% vs. 37.0%, p Conclusions: Risk factors for SCITSR in a multisite Allergy/Immunology practice included administration of the highest immunotherapy doses, inclusion of cat, dog, and grass extracts, and the number of aeroallergenic groups included in the extract. This information helps further characterize risk for patients receiving SCIT.
P102 PROSPECTIVE EFFICACY STUDY OF A SELF-ADMINISTERED ALLERGENIMMUNOTHERAPY PROTOCOL F. Schaffer*,1, T. Hulsey2, M. Ebeling3, W. Wagoner1, 1. San Antonio, TX; 2. Morgantown, WV; 3. Charleston, SC Introduction: We have previously demonstrated the safety of a selfadministered subcutaneous immunotherapy protocol (SCIT; IFAR 2015;5:149-156). Here we report the preliminary results of our IRB approved prospective efficacy study. Methods: Subjects that met the inclusion criteria and chose SCIT therapy constituted the treatment group (N=54). Those that deferred SCIT therapy constituted the control group (N=28). All patients were studied and were on therapy for a mean of 32 months. The study primary outcome measure was the combined symptom plus medication scores (SS+MS). The secondary outcome measure was the rhinoconjuctivitis quality of life (RQLQ) scores. Statistical assessment utilized the student and paired T-test. Results: The study groups were well matched as manifested by baseline measures that demonstrated no significant differences. Patient groups were compared based on common aeroallergen allergies, season, and relevant pollen counts. Treatment patient analyses showed significant improvement (41-56%) compared to baseline indices for SS, MS, SS+MS and RQLQ. In contrast, control group indices demonstrated little to no improvement. Treatment group results demonstrated improvements of 57% (57% (SS, p<0.0001), 36% (MS, p<0.02), 53% (SS+MS, p<0.0001), and 43% (RQLQ, p=0.0001) in comparison to control group indices. These improvements are clinically relevant based on the WAO criteria (Allergy 2007;62:317−324). Meta analyses demonstrated that our study outcomes are similar to those trials that assessed the efficacy of office-based SCIT administration. Conclusions: These results demonstrate that the self-administered SCIT protocol used in this study produced significant and clinically relevant improvement. When contrasted with office-based SCIT studies, our efficacy was found to be equivalent.
S27
Introduction: Penicillin allergy is the most common beta-lactam drug allergy and is estimated to affect approximately 10% of the population. Large-scale efforts are underway nationwide to test and verify documented penicillin allergy in order to promote antibiotic stewardship and improve public health. The purpose of this study is to determine barriers to outpatient referrals to allergy clinic for penicillin testing so that they may be appropriately addressed. Methods: Surveys were electronically distributed to primary care providers in order to assess providers’ perceptions of penicillin allergy and to determine barriers to referral to allergy clinic. Eligible subjects included attending and resident physicians in the Departments of Internal Medicine and Family Medicine. Results: A total of 204 subjects were invited to participate in the study. Eighty-five subjects (42%) completed the survey. Providers identified the following as the most significant barriers to allergy clinic referral: “Patients have multiple other medical problems which take priority in time-limited encounters” (41%), “I did not realize that this service was available for my patients” (26%), “I am concerned that the allergy history is inaccurate or unclear” (12%), “I don’t think my patients will follow through with the referral” (5%), and “Other” (16%). Conclusions: A number of knowledge and logistical gaps have been identified as barriers to outpatient referral for penicillin allergy testing and verification. Further study of techniques to overcome these barriers is warranted.
P104 MAXIMIZING OPPORTUNITIES FOR SKIN PRICK TESTING AT INITIAL ALLERGY CLINIC VISIT USING AN EDUCATIONAL BROCHURE A. Grippen Goddard*,1, B. Davis2, 1. Denver, CO; 2. Iowa City, IA Introduction: Many atopic patients present to allergy clinic taking medications that interfere with allergy skin prick testing (SPT) due to lack of communication amongst providers, clinics and patients. We investigated the effect of a mailed brochure on rates of allergy SPT at an initial clinic visit. Methods: A retrospective chart review was performed on new patients presenting to an Allergy/Immunology clinic from November 2016 to November 2017. An educational brochure describing the allergy SPT procedure and instructions for holding medications was mailed before the appointment. The effect of the intervention was analyzed via prospective chart review from November 2017 to May 2018. Research was exempt from IRB review. Results: We reviewed 96 charts pre-intervention and 79 charts postintervention that were appropriate for allergy SPT. The percentage of patients who were not taking interfering medications and successfully completed allergy SPT rose from 63% (n=60) prior to the intervention to 84% (66) after the intervention (p=0.002). Wait time for new patients decreased from three months to one week after the intervention. Of patients completing a post-intervention survey, 59% (47) reported they had received the brochure more than five days before the appointment. Steroid nasal sprays were held incorrectly by 12 patients, accounting for 86% of incorrectly held medications. Two (2%) adverse events occurred in association with the mailed brochure, namely an urticaria exacerbation and an episode of acute angioedema. Conclusions: Our results suggest that communicating with patients via a mailed brochure is an effective intervention to increase the number of successful allergy SPT’s during the initial visit.