Table 4.

Summary of articles related to case management

Focus/ Intervention	Drug of interest	Articles	Summary of findings
Antimicrobial stewardship (n=19)
Evaluation of documented beta-lactam allergies	All beta-lactam antibiotics	Abrams et al. (2016)110	ICD-9 codes and billing codes were used to identify patients who had underdone assessment for suspected beta-lactam antibiotic allergies for retrospective chart review. Following intradermal testing and oral challenge, 96% of patients with prior history of beta-lactam allergy were advised they could safely re-introduce beta-lactam antibiotics.
		Blumenthal et al. (2019) 99	This retrospective cohort study identified 1,046 test doses challenges prompted by an electronic guideline for hospitalized patients with reported beta-lactam allergies. The antimicrobial stewardship intervention was safe with only 3.8% of patients with beta-lactam allergy histories had a hypersensitivity reaction. Cephalosporin allergy histories conferred a 3-fold risk. Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
		Kwon et al. (2019) 101	A retrospective review of patients with a history of beta-lactam allergies in the EHR found that 15% (6/40) showed a positive cefazolin skin test result compared to only 1.36% (178/13,113) of cases with no such history.
		Shaw et al. (2020) 109	A retrospective review of 589 eligible patients with beta-lactam allergies who underwent allergy service consult, found that changes in the allergy record were recommended for 62% (n = 371) of patients; however, the allergy record was updated after the consult in only 74.9% (n = 278) of patients.
	Penicillins	Chen et al. (2017) 96	A specialized algorithm was used to flag and prioritize eligible inpatients in the EHR for penicillin skin tests and challenges resulting in the removal of penicillin allergy labels in 228 subjects (90.5%) and the use of beta lactams in 85 (38%) of patients who tested negative.
		Sundquist et al. (2017)97	The EHR was screened to identify patients with a history of penicillin allergy and a total of 37 patients were recruited for penicillin skin testing and oral challenge. None of the patients had a positive skin test or oral challenge, however 2 patients (5%) experienced reactions within 24 h.
		Kuder et al. (2020) 104	A retrospective review of pregnant women who underwent penicillin allergy evaluation via skin test found that 44 patients (95.6%) received negative results and 18 patients (39%) completed oral challenge and did not experience adverse reactions.
		Wolfson et al. (2021) 100	A retrospective study of the pregnant patients with penicillin allergies in the EHR found that of 220 patients skin tested, 209 (95%) had their penicillin allergy label safely removed and penicillin allergy testing was associated with significantly reduced broad-spectrum antibiotic use and increased first-line beta-lactam antibiotic use.
	General	Iammatteo et al. (2017) 102	A 5-year retrospective chart review of patients who underwent at least 1 single-blind placebo-controlled graded drug challenge was conducted. The reaction rate to drug and placebo was similar during beta-lactam challenges (9.4% vs 8.2%; P = .9) and during nonsteroidal anti-inflammatory drug challenges (14% vs 7%, P = .5), respectively.
Evaluation of allergy for treatment optimization	All beta-lactam antibiotics	Sigona et al. (2016) 107	A pharmacist-driven beta-lactam allergy interview was effective in switching 65% of eligible patients to beta-lactam therapy and identifying discrepancies between confirmed allergies and those documented in the EHR in 87%. Medical providers accepted 87.5% of pharmacists’ antimicrobial recommendations.
	Penicillins	McDanel et al. (2017) 103	Beta-lactam allergy screening using an electronic best practice advisory and Drug Allergy Clinic referral in orthopedic surgery patients resulted in higher cefazolin use in patients evaluated in the clinic versus those not evaluated (90% vs 77%) and lower use of non-beta-lactam antibiotics (16% vs 27%).
		Blumenthal et al. (2017) 106	Both application with clinical decision support and penicillin skin test increased the use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy by nearly 2-fold and 6-fold respectively.
		Ramsey et al. (2018) 108	Inpatients with penicillin allergies receiving moxifloxacin, intravenous vancomycin, aztreonam, daptomycin or linezolid were identified through an EHR report and a penicillin allergy history algorithm was used to determine eligibility for penicillin skin testing. Forty-seven patients (94%) were skin-test negative and were subsequently transitioned to beta-lactam antibiotic and no patients experienced immediate adverse reaction.
		Englert et al. (2019) 94	Patients with documented penicillin allergy (type I, immunoglobulin E [IgE]-mediated) who were prescribed alternate antibiotics enrolled in a pharmacist-driven PST service to facilitate delabelling of inaccurate penicillin allergies in the EHR. Of 22 patients, all were negative, and 68.2% (15) were successfully transitioned to beta-lactam antibiotics reducing the use of fluoroquinolones and vancomycin.
		Kuruvilla et al. (2020) 105	Using an institutional algorithm for antibiotic selection in penicillin-allergic surgical patients (n = 2296), treatment with cephalosporin increased from 22% at baseline to 80% after algorithm implementation without severe adverse reactions.
	Other antibiotics	Lin et al. (2020) 98	Patients with antibiotic allergy labels which interfered with the preferred antibiotic treatment were identified through physician recommendation in the EHR and 42 patients received oral challenges. In 40 (95%) of these patients, no allergic reaction was observed, and the preferred antibiotic treatment was given. Two (5%) patients developed a non-severe skin reaction after a drug challenge and continued an alternative antibiotic regimen
Improvement of desensitization	All beta-lactam antibiotics	Pandya et al. (2021) 111	A clinician survey found that the creation of standardized electronic beta-lactam antibiotic desensitization order sets results in increased overall efficiency.
Assessment of alternate antibiotic use		Mancini et al. (2021) 112	Of 2,276 inpatients receiving antibiotics for pneumonia at 95 U.S. hospitals, 450 (20%) had a documented penicillin and/or cephalosporin allergy. Inpatients with this documented allergy and pneumonia were less likely to receive recommended beta-lactams and more likely to receive carbapenems and fluoroquinolones.
Referral for allergy delabelling	Penicillins	Wang et al. (2021) 95	Using an attending physician educational session and Best Practice Advisory in the EHR, referrals to the allergy clinic for increased for penicillin-class drug allergies from 1.9% to 13.7% after the educational session with a further increase to 27.8% after the Best Practice Advisory.
Non-antibiotic drug desensitization and rechallenge (n=3)
Assess outcomes of drug desensitization	General	Murray et al. (2016) 115	A retrospective review of EHR of patients undergoing drug desensitization found that of 69 patients, desensitization was completed with no cutaneous reaction in 85% of patients. Reported histories of urticaria and labored breathing during prior exposure were significant in identifying patients who might have a reaction during desensitization.
Risk stratification and evaluation of taxane re-exposure	Taxane	Picard et al. (2016) 114	EHR of patients who had been treated for taxane-related DHRs were retrospectively reviewed to identify patients for re-exposure to taxanes. Of 138 patients desensitized, 29 (21%) had an immediate and 20 (14%) has a delayed DHRs with the procedure. Of 49 patients challenged, 2 (4%) had mild immediate and 1 (2%) had a delayed DHRs with the procedure.
Assessing safety of chemotherapy drug rechallenge protocol	Chemotherapy drugs	Wu et al. (2019) 113	Patients who attempted rechallenge with paclitaxel, docetaxel, carboplatin and oxaliplatin were identified through retrospective chart review. The first rechallenge cycle was completed successfully in 43/46 patients (93.5%) and 42/46 patients (91.3%) were hypersensitivity reaction-free throughout the treatment course under the rechallenge protocol.