Use of Telemedicine for Penicillin Allergy De-Labeling
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Allison Ramsey, MD FAAAAI, Anne M. Holly, RPA-C, Mary L. Staicu, PharmD

Penicillin allergy is the most commonly reported antibiotic allergy. Avoidance of β-lactam antibiotics leads to use of second line therapies. Limited inpatient availability of allergy/immunology consultation may impede the use of penicillin skin testing (PST). We sought to evaluate the utility of telemedicine for inpatient penicillin allergy consultation.


An infectious disease PharmD identified adult inpatients with penicillin allergy receiving any antibiotics through an electronic medical record (EMR) report. Consented patients were administered a penicillin allergy history algorithm to determine appropriateness for PST, which was then performed by a physician assistant (PA). A telemedicine consult was performed by an allergy/immunology physician via Microsoft Lync. Patients were surveyed regarding their telemedicine experience. Negative PST patients were transitioned to a β-lactam antibiotic if indicated.


A total of 338 patients were screened and 112 approached for study consent. Fifty patients consented to the study. Historical reactions to penicillin included rash (26%), hives (24%), angioedema (18%), unknown (12%), anaphylaxis (10%), itching (4%), shortness of breath (4%), and loss of consciousness (2%). Forty-six patients (92%) were PST negative. Thirty-three patients were transitioned to a β-lactam antibiotic. Patients rated their experience as an average of 4.5 (SD±0.54) on a scale of 1 (highly unsatisfied) to 5 (highly satisfied). The average physician time for telemedicine consultation was 4 minutes and 48 seconds (SD±1:47). An estimated 45 minutes (SD±5:31) per patient was saved in physician travel time.


Telemedicine facilitates penicillin-allergy de-labeling, and carries high patient satisfaction scores. It is an efficient use of allergy/immunology physician time and expertise.