Vanderbilt Health’s Drug Allergy Clinic has innovated a model that could change the way doctors elsewhere assess antibiotic allergies in transplant patients, leading to increased efficiency for clinicians and fewer appointments for patients, according to newly published research.
The research, recently posted online in the journal Transplant Infectious Disease, details Vanderbilt Health’s dramatically different approach. Rather than evaluate pretransplant patients for a single allergy during a clinic visit as in conventional practice, the Drug Allergy Clinic has evaluated patients for multiple antibiotic allergies at once for more than a decade.
Such evaluations are critical because immunocompromised solid organ transplant patients need first-line antibiotics — such as cephalosporins and sulfonamides — to prevent infections. But many of those same patients are labeled with multiple antibiotic allergies prior to transplant, which is a significant barrier both to the success of the transplant and even receipt of a transplant at some centers.
That’s where the Drug Allergy Clinic comes in. Through testing, the clinic can determine that patients do not have allergies to certain medications, a process called delabeling. By delabeling multiple antibiotics in the same visit, the Vanderbilt Health team can reduce the number of visits from patients, many of whom drive hours for care at the Vanderbilt Transplant Center.
“Our team at the Drug Allergy Clinic has innovated a model that is leading the world when it comes to assessing antibiotic allergies in transplant patients,” said Cosby Stone Jr., MD, MPH, assistant professor of Medicine and corresponding author of the study. “We are the first program in the world that routinely and safely evaluates more than one antibiotic allergy during a single clinic visit, using a multiple antibiotic allergy evaluation strategy that we have refined over the course of the last 10 years.”
Stone and other Vanderbilt University Medical Center researchers conducted a retrospective cohort study of 184 solid organ transplant patients evaluated at the Drug Allergy Clinic from 2014 to 2024. A total of 53 of those patients had labels of two or more antibiotic allergies. Of these patients, 93% had labels successfully removed during their visits.
With the multiple antibiotic allergy evaluation strategy (MAAES), the clinic reduced the number of visits for patients by 61%, the study found.
“Because these patients are often time-poor with many competing evaluations, the one-stop, streamlined design of MAAES is invaluable — improving efficiency, reducing burden and giving patients clarity, safety and confidence in their treatment,” said co-author Elizabeth Phillips, MD, the founder of the Drug Allergy Clinic.
“I am excited by the promise that strategies like MAAES will ultimately be integrated into all allergy care plans across the U.S. and globally,” added Phillips, the John A. Oates Professor of Medicine and professor of Dermatology, Pharmacology, and Pathology, Microbiology and Immunology.
Other authors of the paper are first author Rebecca Lee, MPH; Grace Koo, MD, assistant professor of Medicine; Matthew Krantz, MD, assistant professor of Medicine; and Christine Allocco, MSN, RN. The research was supported by the Agency for Healthcare Research and Quality (grant R01HS030234).
“Working on this project has been so much fun,” Lee said. “Transplant patients often face a ‘maze’ when trying to get good care while dealing with untested antibiotic allergies. Looking at how to help them get out of those troubles with a multiple antibiotic allergy evaluation strategy has been super rewarding.”
