Photo caption: Dr. Kim Frodl, director of Student Health Service, is collaborating with an allergist at Mayo Clinic Health System on a study to help students who have penicillin allergy labels in their medical files determine if those labels are up to date and accurate. (Photo by Shane Opatz)
The University of Wisconsin-Eau Claire’s Student Health Service and Mayo Clinic Health System are working together on a first-of-its-kind study to ensure that penicillin allergy labels in students’ medical records are current and accurate, information that can have lifelong health care implications.
“There are many people, including some of our students, who are labeled as having a penicillin allergy by mistake or it’s something they’ve outgrown but it’s still in their medical records,” says Dr. Kim Frodl, SHS director and a physician at Mayo Clinic Health System. “It’s important that their records are up to date so they can get the best care possible now but also in the future as their medical needs become more complex.”
The penicillin group of antibiotics still is the first-line therapy for many common infections and is used preventatively for dental procedures and surgery. However, if patients have a penicillin allergy label on record, they will be treated with alternative antibiotics, which may not be as safe, effective or affordable, Frodl says of why there is a “push to de-label whenever possible.”
Dr. Adela Taylor, an allergist at Mayo Clinic Health System, agrees, noting that a penicillin allergy is associated with longer hospitalizations, worse outcomes and higher health care costs to patients throughout their lives. Yet studies estimate that more than 90% of people with a penicillin allergy are inaccurately labeled and are not allergic, she says.
“It is important to accurately identify medication allergies in everyone, and the earlier we remove inappropriate penicillin allergy labels, the more health benefits that person experiences,” Taylor says.
In recent years, there has been growing evidence that direct oral challenges to amoxicillin in people with allergy labels is a safe and low-risk way to determine if they are actually allergic, Taylor says. However, so many people have penicillin allergy labels that it’s not practical for them all to be assessed by allergists. So, Taylor, in conjunction with Frodl, developed a penicillin allergy testing process that can be performed outside of an allergy practice.
SHS is using this process to assess UW-Eau Claire students who have penicillin allergy labels and want to be part of the study. The “Penicillin De-Labeling Study” gives students a free, convenient and low-risk way to determine if they are allergic to penicillin and, if not, to remove the label from their medical records, Frodl says.
The UW-Eau Claire initiative is the first study to be performed in a student health center without direct involvement of an allergy department, Taylor says, crediting the UW-Eau Claire research agreement with Mayo Clinic Health System with making the project possible.
A model program
For the study, Frodl identified UW-Eau Claire students whose medical records included a penicillin allergy label. SHS then sent an email to 494 students inviting them to complete a survey, which SHS used to assess each respondent’s allergy risk.
Students considered to have a low-risk allergy — such as those who haven’t had a reaction to penicillin for 10-plus years — were invited to be part of the de-labeling project.
During the study, participating students come to SHS, where Frodl completes a brief physical exam and then gives them a low dose of penicillin in liquid form. Students are monitored at SHS for 75 minutes, with virtual follow-up contact continuing for two days. If they have no reaction to the penicillin during that time, the allergy labels are removed from their medical records.
To-date, 61 UW-Eau Claire students with low-risk, known penicillin allergies have participated in the screenings. All but one of them were found to not have a penicillin allergy, Frodl says.
“That number is right on track for what we expect,” Taylor says. “Previous studies of direct oral challenge to amoxicillin report immediate and delayed reactions at about 2%-3% each.”
Students are taking the de-labeling study seriously, something that has surprised and impressed her, Frodl says, noting that many students told her their parents encouraged them to participate.
“They seem to get that this is important,” Frodl says of students. “They’re at fairly young ages, but they still get that this matters and they want to own it, so they are taking the time to come in.”
Frodl says many of the students participating in the oral challenge study were likely given penicillin allergy labels as young children since penicillin often is used to treat ear infections and other common ailments in infants, toddlers and preschoolers.
“They get the label before age 4, and they just carry it with them into adulthood,” Frodl says. “Now, they have a free and super easy way to find out if they still have the allergy.”
While not all students with penicillin allergies are choosing to participate in the study, Frodl hopes the study inspires them to at least talk about their allergy label with their primary care providers.
“This is an opportunity to raise awareness,” Frodl says. “Hopefully, this is something that now is on these students’ radar.”
Mayo Clinic Health System’s Research and Innovation Council provided funding for UW-Eau Claire to test 150 students through the oral challenge study, so the de-labeling effort will continue through the fall semester.
While the study will end, SHS now has an established process it can use as new students enroll who have penicillin allergy labels, Taylor says. The assessment model also can be used when a student with a penicillin allergy label comes to SHS with symptoms of an infection, she says.
Her hope, Taylor says, is that UW-Eau Claire’s de-labeling study will serve as a model that other universities can follow.
“I think what we have learned here can be replicated on campuses across the country,” Taylor says.
Taylor says she appreciates that the strong relationship between UW-Eau Claire and Mayo Clinic Health System can make shared projects like this one possible.
“Without the funding and support from both organizations, and the hard work from Dr. Frodl, my idea of de-labeling students with a penicillin allergy would still be just an idea,” Taylor says. “I hope projects like this help spread awareness about the need and ease of removing inappropriate medication allergy labels, especially penicillin.”