Dr. Jason Trubiano

New Drug and Antibiotic Allergy Service opens

Austin Health's new Drug and Antibiotic Allergy Service (DAAS) provides a fully-multidisciplinary and comprehensive service for the testing and diagnosis of drug and antibiotic allergies.

The clinic - which started operating last month - brings together a multidisciplinary team of doctors, nurses and pharmacists into a comprehensive service, to see patients with a wide range of drug allergies.

Dr. Jason Trubiano, who is director of DAAS, says that while each type of testing was available previously, patients sometimes needed to be referred to a number of different clinics - and even different hospitals - before they received the correct allergy label. In some cases, patients stopped attending appointments before they found out which drug they reacted to.

"If you have an operation on your hip, you might receive antibiotics, muscle relaxants, pain relief medication and anaesthetic drugs," Dr. Trubiano.

"If you then have an adverse drug reaction, we don't know which drug has caused it. Infectious Diseases has run an Antibiotic Allergy Service since 2015 that's been very successful in de-labelling patients who have been incorrectly labelled as having an antibiotic allergy," Dr. Trubiano says

"If we suspected that you had an allergy to the perioperative or anaesthetic drug, we'd then have to refer you elsewhere. Now, patients who come to clinic will leave with an answer by the end of the day."

The Clinic will also allow approximately 25 per cent more patients who are suspected to have an antibiotic allergy to be seen each year - which Dr. Trubiano says is a win for both antimicrobial stewardship, and the individual patient.

"There have been studies that have shown that having an antibiotic allergy label is associated with being more likely to have a resistant infection. Our data also says that these patients are more likely to receive an inappropriate antibiotic," Dr. Trubiano says. He says that clinic data has shown that up to 90 per cent of patients who believe they have an allergy to antibiotics have no such allergy at all.

When patients are labelled as allergic to a highly-effective drug, doctors are forced to prescribe a second-line antibiotic, increasing the likelihood of causing antibiotic resistance.

As well as opening the new service, Dr. Trubiano is principal investigator in a research project that will teach Austin Health's computer systems to identify patients who have had an adverse drug reaction, using a process called natural language processing (NLP).

The project has received $15,000 in funding from the Austin Medical Research Foundation, which will cover the cost of developing the NLP software, in collaboration with Department of Computing and Informatics at the University of Melbourne. Staff from Infectious Diseases and Pharmacy will then review patient records and flag key words that suggest a patient may have had a drug reaction - say ‘rash' and ‘amoxicillin', training the computer system to look for the same words automatically.

"It's basically training a computer to support the Adverse Drug Reaction pharmacist," says Dr. Trubiano, "and in real-time. If someone is in the Emergency Department and has a rash, by the time they're in the ward, they'll have been flagged."

Dr. Trubiano hopes that the project will improve the detection of adverse drug reactions, a process that currently relies on doctors or pharmacists filling in the Adverse Drug Reaction form on the Hub.

"I estimate we'll pick up another 100 or 200 patients a year that are missed, or just get labelled as having a penicillin allergy, or are told they're allergic to lots of drugs," Dr. Trubiano says. He says that this will be on top of approximately 600 adverse drug reactions picked up each year through the manual reporting system by our Adverse Drug Reaction Committee, already a leader in the area.

"Patients will be referred for allergy testing, leading to more appropriate allergy labels, and hopefully, safer drug and antiobiotic prescribing," Dr. Trubiano says.

The Drug and Antibiotic Allergy Service operates all day every Thursday from the Ambulatory Care Centre at Austin Hospital, and welcomes referrals from across Austin Health.