Background As part of the investigation of anaphylaxis, it is recommended that allergy testing (ATs) be performed in day hospital, because of the anaphylactic risk requiring special hospital surveillance. Skin tests (SKs) and oral provocation tests (OPTs) are currently performed in our hospital in dermatology, paediatrics and pneumology departments according to heterogeneous protocols. For the diagnosis of non-marketed allergens, only OPTs preparations are made in our hospital pharmacy. SKs are manufactured extemporaneously by nurses before administration.
Purpose Following a dermatologist’s request that ATs be performed in day hospital, we decided that drugs will be manufactured by the pharmacy and that it was necessary to harmonise protocols of different services. But how should it be put in place?
Material and methods Establishment of a working group comprising pharmacists, pulmonologists, dermatologists, paediatricians, doctor of medical information and the financial affairs department to: determine allergens to be tested; work on a homogenisation of protocols; determine the correct codification of acts for the costing of the care; determine an organisation between the prescribers’ requests; and a preparation of ATs by the pharmacy, according to processes similar to other institutions.
Results Five drug classes have been identified as priorities for development: antibiotics, analgesics, local anaesthetic drugs, iodinated contrast products and nonsteroidal anti-inflammatory drugs. ATs will be made in day hospital one day per week for all medical specialties, and their manufacture will be carried out the day before by the pharmacy. During the implementation of these ATs, we encountered difficulties in standardising protocols. Indeed in paediatrics, the target dose of these tests varies according to the weight of the child. In addition to this, it is necessary to produce duplicate SKs to prevent the failure of administration due to children’s movements. We therefore decided to standardise adult protocols separately from paediatrics.
Conclusion This work required close collaboration between prescribers and pharmacists. It will allow for better patient management, ATs manufacturing according to good preparation practices guidelines, but also significant financial value through day hospital costing. A study of the stability of dilutions of molecules tested will subsequently be necessary.
References and/or acknowledgements No conflict of interest.
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