125 Cues to improve antibiotic-allergy registration: A mixed-method stu 5 Analysis of the quality of antibiotic allergy registrations in primary care Our study provides detailed new insight into what is lacking in antibiotic allergy registrations. In our quality assessment, non-allergic reactions interpreted as antibiotic allergic reactions accounted for 14.3% of all registrations, a figure comparable to the 11.7% reported by Salden et al. (1). This is however an underestimate of the actual number of reactions that are incorrectly labelled as an allergy: 56.3% of antibiotic allergy registrations lacked essential information such as a description of symptoms, their time of onset and/or duration. Such detailed information is needed in order to determine the type and severity of the reaction and to be able to decide whether an antibiotic can be prescribed safely. Although delayed type reactions cause discomfort, they are rarely life-threatening except in very rare cases such as Stevens-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS). Risk of recurrence of a mild delayed type reaction is low and there is no additional risk of an immediate type reaction with the exception of severe cutaneous adverse reactions (16). Therefore, a mild delayed type reaction would not be an absolute contra-indication for the antibiotic in question. To be able to decide on re-exposure, a complete antibiotic allergy registration is needed. When the details of the reaction can’t be retrieved, for example if the patient does not remember and there is no documentation, this should be indicated in the EMR. Determinants of incorrect antibiotic allergy registration Health care providers’ lack of knowledge regarding the differentiation of allergic versus non-allergic reactions was perceived as a major determinant of incorrect registration. Similar findings were reported in one primary care study and two studies of hospital doctors (17–19). Improved education of healthcare providers registering antibiotic allergies is a possible solution to overcome incorrect interpretations. Interviewees from all domains perceived patient related factors as important determinants of incorrect antibiotic allergy registrations. Firstly, patients may not remember the details of the reaction, especially if the reactions occurred in remote childhood. Secondly, patients may interpret side effects as an allergy and express a wish not to receive a particular antibiotic in the future, often resulting in the incorrect registration of an antibiotic allergy. A study by De Clercq et al. reported similar findings in primary care (17). Interviewees also stated that a clear explanation and effective communication with the patient can help to avoid an incorrect registration. Patientorientated research in which patients are interviewed concerning their experiences
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