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Persistent Penicillin Allergy Label in Pharmacies after Penicillin Allergy De-labeling [Meeting Abstract]

Diaz, A M; Fonacier, L; Stern, H; Mawhirt, S; Banta, E; Sani, S
Rationale: Carrying a penicillin allergy label is associated with increased healthcare costs and adverse events. De-labeling a penicillin allergy can optimize antimicrobial stewardship and improve patient care.
Method(s): We performed an IRB-approved retrospective study of patients over 11 years-old, who were de-labeled of penicillin allergy (negative skin testing and aminopenicillin oral challenge) in our clinic between May 2019 and May 2022. Patients had their penicillin allergy removed from our electronic medical record (EMR) and were given a wallet card denoting results. A letter with fax confirmation of receipt was sent to both primary care physician and pharmacy. EMR review and phone interviews with patients and pharmacies were subsequently conducted to determine penicillin allergy status and antibiotic prescribing patterns.
Result(s): A total of 78 charts were reviewed: 68 underwent phone interviews, 9 were lost to follow up, and 1 was deceased. From these charts, 77 (99%) remained de-labeled in our EMR, whereas 24 (31%) had an active penicillin allergy listed in their pharmacy. Out of 68 patients interviewed, 66 (97%) recalled a negative penicillin allergy result, 30 (44%) took penicillins since de-labeling, 31 (46%) were not prescribed penicillins, 4 (6%) avoided penicillins, while 3 (4%) reported unknown antibiotic use.
Conclusion(s): This study demonstrates that our pencillin de-labeling protocol is effective in maintaining a non-allergic status and allowing for subsequent penicillin administration. However, the discrepancy in allergy records between our EMR and patients' pharmacies exemplifies the need to identify barriers in universally de-labeling patients.
ISSN: 1097-6825
CID: 5509742

Capturing total steroid burden in patients with atopic dermatitis and asthma

Fonacier, Luz; Banta, Erin; Mawhirt, Stephanie; Noor, Irum; Feldman, Eleanor; Armstrong Martin, Robert; Akerman, Meredith; Sani, Sonam
PMID: 36065113
ISSN: 1539-6304
CID: 5332372

Approach to the rash from an allergy and immunology perspective

Chapter by: Sani, Sonam; Fonacier, Luz
in: Allergic and Immunologic Diseases: A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases by
[S.l.] : Elsevier, 2022
pp. 471-510
ISBN: 9780323953238
CID: 5550622

Real Time Assessment of Steroid Use in Patients with Atopic Dermatitis [Meeting Abstract]

Sani, Sonam; Mawhirt, Stephanie; Banta, Erin; Schneider, Amanda; Fonacier, Luz
ISSN: 0091-6749
CID: 4821182

A Hands-on Approach to Contact Dermatitis and Patch Testing

Schmidlin, Kristin; Sani, Sonam; Bernstein, David I; Fonacier, Luz
Contact dermatitis (CD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. While history and physical exam can be helpful in distinguishing between irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), the gold standard for diagnosing ACD is patch testing. While the actual patch test (PT) procedure and application is relatively straightforward, the decisions involving which allergens to use, interpretation of results, determination of relevant allergens and subsequent patient management requires more skill and expertise. Often, the distribution of the presenting dermatitis can provide insight into the potential causative allergens and should be taken into account when selecting PT allergens. Commercially available PT panels and personal care products can be used for patch testing. Determining the clinical relevance of PT results is a critical component of the PT procedure. Patients must be educated on avoidance of relevant allergens and given guidance on alternative products available for use. Special populations, including children with ACD, occupational contact dermatitis (OCD), and patients with biomedical devices have unique allergen considerations and PT panels should be directed as such to address all potential allergens.
PMID: 32112924
ISSN: 2213-2201
CID: 4324962

Utility of an EMR-Tool to Monitor Total Steroid Burden in Patients with Atopic Dermatitis and Asthma [Meeting Abstract]

Sani, S; Banta, E; Mawhirt, S; Noor, I; Schneider, A; Nassau, S; Feldman, E; Fonacier, L
Rationale: Cutaneous, inhaled, intranasal and systemic corticosteroids(CS) are commonly prescribed for the treatment of atopic dermatitis(AD), asthma, and allergic rhinitis. The cumulative burden of these steroids in individual patients are not routinely assessed by providers and can lead to adverse effects. We sought to use an EMR-tool to increase documentation of the total steroid burden(SB) in our patients with atopic dermatitis and asthma.
Method(s): A SB EMR-tool was used for 99 AD encounters and 64 asthma encounters over an 18-month period. Data collected included corticosteroid type, potency, frequency, side effects, interventions and counseling.
Result(s): There were 99 AD encounters assessed in 58 patients(53% female, mean age of 31). Of these 99 encounters using topical corticosteroids(TCS), 24 were using inhaled CS; 12 using intranasal CS and 8 using systemic CS. The most common side effects encountered while on TCS included: pigment changes(n=20), skin atrophy(n=11), easy bruising(n=7), telangiectasias(n=6), striae(n=6), rosacea(n=3), and hair growth(n=2). Twenty-eight encounters(28%) had an intervention: 10 decreased dose, 3 decreased potency and 15 discontinued TCS. 85 encounters(86%) documented patient counseling. There were 64 asthma encounters assessed in 49 patients(63% female, mean age of 56). Of these 64 encounters using inhaled CS, 27 were using intranasal CS and 18 using systemic CS. The most common side effects encountered while using inhaled CS included: candidiasis(n=6) and hoarseness(n=1). Four encounters(6.25%) had an intervention: 3 decreased dose, 1 discontinuation. 62 encounters(97%) documented patient counseling.
Conclusion(s): Using our EMR-tool facilitates the identification and tracking of total SB in patients, associated side effects and leads to meaningful intervention.
ISSN: 1097-6825
CID: 4315122

Risk stratification of systemic reactions to subcutaneous immunotherapy: A retrospective study

Sani, Sonam; Gupta, Ratika; Fonacier, Luz; Aquino, Marcella
Background: Subcutaneous allergen immunotherapy (SCIT) is a very effective treatment modality; however, it can be associated with both local and systemic reactions (SR). Identifying patient factors that predict SR remains paramount. Objective: Our aim was to identify the rate of SRs to SCIT as well as identify patient risk factors associated with the development of SRs. Methods: We conducted an institutional review board approved 10-year retrospective chart review of 459 patients who received SCIT in our clinic. The patients were placed into cohorts according to age, which included pediatric (5-18 years), adult (19-64 years), and senior (>65 years) patients. Results: An SR (N = 177) was identified in 24.8% of the patients (n = 114). The incidence of SR per injection was 0.2% (177 SRs of 74,183 total injections). SRs were identified as class 1 (n = 152), class 2 (n = 21), class 3 (n = 2), and class 4 (n = 2) according to the 2010 World Allergy Organization's SR grading system. There were no observed differences in the number of SRs with respect to age group. Female patients were more likely to have an SR (p = 0.02) overall as well as more than one reaction (p = 0.002). Other risk factors included the following: a patient-reported history of food allergy (p = 0.05), drug allergy (p = 0.005), or positive skin test result to cat and/or dog (p = 0.01). In addition, patients who were receiving SCIT to cat and/or dog (p = 0.004) or to dust mite (p = 0.03) were more likely to have an SR. Conclusion: In our patient population, the majority of SRs to SCIT occurred in female patients, patients with a history of drug or food allergies, and those who were receiving pet or dust-mite SCIT.
PMID: 31514792
ISSN: 1539-6304
CID: 4112202

Assessing Demographic Factors That Predict the Long- Term Effectiveness of Penicillin Allergy De-labeling [Meeting Abstract]

Sani, Sonam; Fonacier, Luz S.; Aquino, Marcella R.
ISSN: 0091-6749
CID: 3693702


Sani, S.; Fonacier, L.; Aquino, M.
ISSN: 1081-1206
CID: 3693692

Systemic Reactions to Subcutaneous Immunotherapy (SCIT): A Retrospective Study [Meeting Abstract]

Sani, Sonam; Fonacier, Luz S.; Davis-Lorton, Mark A.; Fazzari, Melissa; Aquino, Marcella R.
ISSN: 0091-6749
CID: 3693682