Development and Validation of a Mobile Clinical Decision Support Tool for the Diagnosis of Drug Allergy in Adults: The Drug Allergy App

Elkhalifa, Shuayb and Bhana, Rehan and Blaga, Andreea and Joshi, Siddharth and Svejda, Martin and Vidhya, Kasilingam and Tomaz, Garcez and Giorgio, Calisti (2021) Development and Validation of a Mobile Clinical Decision Support Tool for the Diagnosis of Drug Allergy in Adults: The Drug Allergy App. The Journal of Allergy and Clinical Immunology: In Practice. ISSN 2213-2198

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Abstract

BACKGROUND: Penicillin allergy overdiagnosis has been associated with inappropriate antibiotic prescribing, increased antimicrobial resistance, worse clinical outcomes, and increased health care costs.

OBJECTIVE: To develop and validate a questionnaire-based algorithm built in a mobile application to support clinicians in collecting accurate history of previous reactions and diagnosing drug allergy appropriately.

METHODS: A survey was completed by 164 medical and nonmedical prescribers to understand barriers to best practice. Based on the survey recommendations, we created a 10-item questionnaire-based algorithm to allow classification of drug allergy history in line with the National Institute for Health and Care Excellence guidelines on drug allergy. The algorithm was incorporated into a mobile application and retrospectively validated using anonymized clinical databases at regional immunology and dermatology centers in Manchester, United Kingdom.

RESULTS: A total of 55.2% of prescribers (95% confidence interval, 47% to 63.4%) thought it impossible to draw a firm conclusion based on history alone and 59.4% (95% CI, 51.4% to 67.5%) believed that regardless of the details of the penicillin allergy history, they would avoid all b-lactams. A drug allergy mobile application was developed and retrospectively validated, which revealed a low risk for misclassification of outcomes compared with reference standard drug allergy investigations in the allergy and dermatology clinics.

CONCLUSIONS: Perceived lack of time and preparedness to collect an accurate drug allergy history appear to be important barriers to appropriate antimicrobial prescribing. The Drug Allergy App may represent a useful clinical decision support tool to diagnose drug allergy correctly and support appropriate antibiotic prescribing.

Item Type: Article
Identification Number: https://doi.org/10.1016/j.jaip.2021.07.057
Date: 8 September 2021
Uncontrolled Keywords: Algorithm Drug Allergy Application Drug Allergy App Drug allergy Decision support tool Reference standard allergy test Inaccurate penicillin allergy NICE Prescribers Survey Retrospective validation
Subjects: CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-01 - medical sciences (non-specific)
CAH11 - computing > CAH11-01 - computing > CAH11-01-03 - information systems
CAH22 - education and teaching > CAH22-01 - education and teaching > CAH22-01-01 - education
Divisions: Faculty of Computing, Engineering and the Built Environment > School of Computing and Digital Technology > Department of Digital Transformation
Depositing User: Rehan Bhana
Date Deposited: 08 Oct 2021 08:51
Last Modified: 08 Oct 2021 08:51
URI: http://www.open-access.bcu.ac.uk/id/eprint/12233

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