Lee Rachel U, Banks Taylor A, Waibel Kirk H, Rodriguez Rechell G
Naval Medical Center San Diego, Division of Allergy/Immunology, NTC Branch Health Clinic, 2051 Cushing Rd. San Diego, CA.
Walter Reed National Military Medical Center, Division of Allergy/Immunology, 8901 Rockville Pike, Bethesda, MD.
Mil Med. 2019 Mar 1;184(3-4):e163-e168. doi: 10.1093/milmed/usy194.
Penicillin allergy is the most common drug allergy reported. About 8-10% of individuals in the USA have a documented penicillin allergy, yet 90% are not truly allergic to penicillin. A penicillin allergy "label" results in increased antibiotic-related adverse reactions and increased health care costs, thus impacting the overall "readiness" of the military.
A review of the current literature and approaches to penicillin allergy and "de-labeling" a patient who reports penicillin allergy was conducted and future strategies to identify and assess military beneficiaries were outlined. Military allergists had a formal discussion at the Tri-service Military Allergy Immunology Assembly regarding the state of penicillin allergy testing in military allergy clinics.
A PubMed search yielded 5,775 results for "penicillin allergy" and 484 results for "penicillin allergy testing." There were two formalized penicillin testing programs in the military treatment facilities. In 2017, the military trained nearly 165,000 new recruits. If 5-10% reported a penicillin allergy and 90% were de-labeled, that would yield a $15-30 million cost savings annually. Further, de-labeling of the 9.4 million active duty, beneficiaries and retirees with a 90% success rate could result in even greater savings for the military health care system.
A penicillin allergy label is a risk to military readiness secondary to associated increases in the length of hospitalizations and emergency department and medical visits. Penicillin de-labeling is a simple intervention that can improve readiness, significantly decrease health care costs and prevent antibiotic resistance, as well as antibiotic-associated adverse events. The military allergist should be "front and center" providing expertise guidance and leadership for clinic and hospital-based penicillin de-labeling efforts which are nested within the antibiotic stewardship programs.
青霉素过敏是报告最多的药物过敏。在美国，约8% - 10%的人有记录表明对青霉素过敏，但其中90%并非真正对青霉素过敏。青霉素过敏“标签”会导致抗生素相关不良反应增加以及医疗保健成本上升，从而影响军队的整体“战备状态”。
对当前关于青霉素过敏及对报告青霉素过敏患者进行“脱敏”的文献和方法进行了综述，并概述了识别和评估军事受益人的未来策略。军事过敏症专家在三军军事过敏与免疫学大会上就军事过敏诊所中青霉素过敏检测的现状进行了正式讨论。
在PubMed上搜索“青霉素过敏”得到5775条结果，搜索“青霉素过敏检测”得到484条结果。军事治疗机构中有两个正式的青霉素检测项目。2017年，军队训练了近16.5万名新兵。如果5% - 10%的人报告对青霉素过敏且90%被脱敏，那么每年可节省1500万至3000万美元成本。此外，对940万现役军人、受益人及退休人员进行脱敏且成功率达90%，可为军事医疗系统带来更大节省。
青霉素过敏“标签”因住院时间、急诊科就诊及医疗就诊次数增加而对军事战备状态构成风险。青霉素脱敏是一种简单的干预措施，可改善战备状态，显著降低医疗保健成本，预防抗生素耐药性以及抗生素相关不良事件。军事过敏症专家应处于“前沿和核心位置”，为嵌套在抗生素管理项目中的临床和医院青霉素脱敏工作提供专业指导和领导。
