Digital self-assessment identifies low-risk patients with penicillin, sulfa allergy

Key takeaways:

• The specificity and sensitivity of the self-assessment were 84.9% and 80.1%, respectively.
• The tool does not replace clinician assessment and can reliably populate a low-risk clinic, an expert said.

WASHINGTON — A digital self-assessment demonstrated effectiveness at identifying low-risk patients with penicillin or sulfa allergies, results of a study here showed.

Morgan Rose, MBBS, DTM&H, FRACP, from the Peter MacCallum Cancer Center, in Australia, noted that one of the reasons for the study “was the fact that the vast majority of penicillin allergies are low risk, and we know that those individuals can be safely delabeled with direct oral challenge as opposed to skin testing, so having a dedicated low-risk clinic would really let you access the maximum number of patients and have a much bigger impact on the removal of their allergy label.”

However, “that triage step of identifying who’s actually low risk and who can come to your clinic is pretty burdensome in terms of time, so I was looking for a way I could automate that process, at least to identify the vast majority of people who are low risk to then allow them to flow into that low-risk clinic,” Rose told Healio at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

In the study, the researchers used a digital penicillin and sulfa allergy self-assessment that was developed from the PEN/SULF-FAST clinical decision rule. A weblink to the assessment was then delivered to adults who were referred to the Austin Health antibiotic allergy clinic with a penicillin or sulfa allergy from January to October of 2023.

The assessment was given to 392 patients (mean age, 54 years), among whom 62% completed it.

Among those patients, 86% underwent a clinician assessment, with 57.4% (105 penicillin, 15 sulfa) identified as low-risk on the self-assessment.

Rose and colleagues noted that of the patients who were low risk on self-assessment, 90.8% (95 penicillin, 14 sulfa) were confirmed as low risk by a clinician.

Overall, the self-assessment demonstrated a:

• sensitivity of 80.1%;
• specificity of 84.9%;
• positive predictive value of 90.8%; and a
• negative predictive value of 69.7%.

Among patients who underwent a clinician assessment, 33.5% completed feedback, with 90% reporting positive or very positive ratings for the self-assessment’s usability and overall satisfaction.

The self-assessment “does not replace an allergist, this does not replace your clinical assessment, but it can very reliably populate a low-risk clinic, and you know that the vast majority of patients who attend it will be appropriate for that clinic, so it should really streamline that whole referral process,” Rose said.