Cargando…
Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study
Beta-lactam allergy is a common problem in everyday medical practice and is recognized as a major public health issue. Carrying this label frequently leads to the avoidance of all beta-lactam antibiotics, favoring the use of other less preferred classes of antibiotics, that are more expensive and as...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234877/ https://www.ncbi.nlm.nih.gov/pubmed/35769578 http://dx.doi.org/10.3389/falgy.2022.853587 |
_version_ | 1784736178404065280 |
---|---|
author | Iuliano, Sarah Senn, Laurence Moi, Laura Muller, Yannick D. Ribi, Camillo Buss, Guillaume Comte, Denis |
author_facet | Iuliano, Sarah Senn, Laurence Moi, Laura Muller, Yannick D. Ribi, Camillo Buss, Guillaume Comte, Denis |
author_sort | Iuliano, Sarah |
collection | PubMed |
description | Beta-lactam allergy is a common problem in everyday medical practice and is recognized as a major public health issue. Carrying this label frequently leads to the avoidance of all beta-lactam antibiotics, favoring the use of other less preferred classes of antibiotics, that are more expensive and associated with more side effects and increased antimicrobial resistance. Therefore, delabeling a beta-lactam allergy is part of antimicrobial stewardship programs. Herein, we retrospectively examined the clinical records of 576 patients who were referred to our center for a label of allergy to beta-lactam antibiotics and were systematically investigated following a standardized algorithm. Our main aim was to evaluate the frequency of confirmed immediate- and delayed-type allergy to commonly prescribed subclasses of beta-lactam antibiotics (penicillin and cephalosporin), as well as the negative predictive value (NPV) and the sensitivity of skin tests. Our secondary aims were to examine the safety of beta-lactam skin testing and drug challenge. We identified that 260 patients reported a history of immediate reactions, 131 of delayed reactions, and 114 of unknown timing or mechanism of reactions. Following assessment and testing, 86 (18.3%) patients had a confirmed allergy to any beta-lactam antibiotics; 63 (13.4%) with an immediate- and 23 (4.9%) with a delayed-type reaction. Most frequently identified confirmed allergy was to penicillins (65 patients), followed by cephalosporins (21 patients). When immediate-type reactions were examined, NPV of skin tests were 96.3% and 100% for penicillins and cephalosporins, respectively. When delayed reactions were considered, NPV were 91.9 and 87.5% for penicillins and cephalosporins, respectively. Evaluation of the safety of skin tests according to the standardized procedure showed that systemic allergic reactions occurred in only 0.7% of skin tests and in 3.1% of drug challenges. Overall, our data indicate that only 18.3% of patients with a beta-lactam allergy label have a confirmed allergy and non-allergic patients can be safely delabeled through allergic workup based on skin tests and drug challenge. This approach supports the policy of saving second-line antibiotics through a standardized allergy workup. |
format | Online Article Text |
id | pubmed-9234877 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92348772022-06-28 Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study Iuliano, Sarah Senn, Laurence Moi, Laura Muller, Yannick D. Ribi, Camillo Buss, Guillaume Comte, Denis Front Allergy Allergy Beta-lactam allergy is a common problem in everyday medical practice and is recognized as a major public health issue. Carrying this label frequently leads to the avoidance of all beta-lactam antibiotics, favoring the use of other less preferred classes of antibiotics, that are more expensive and associated with more side effects and increased antimicrobial resistance. Therefore, delabeling a beta-lactam allergy is part of antimicrobial stewardship programs. Herein, we retrospectively examined the clinical records of 576 patients who were referred to our center for a label of allergy to beta-lactam antibiotics and were systematically investigated following a standardized algorithm. Our main aim was to evaluate the frequency of confirmed immediate- and delayed-type allergy to commonly prescribed subclasses of beta-lactam antibiotics (penicillin and cephalosporin), as well as the negative predictive value (NPV) and the sensitivity of skin tests. Our secondary aims were to examine the safety of beta-lactam skin testing and drug challenge. We identified that 260 patients reported a history of immediate reactions, 131 of delayed reactions, and 114 of unknown timing or mechanism of reactions. Following assessment and testing, 86 (18.3%) patients had a confirmed allergy to any beta-lactam antibiotics; 63 (13.4%) with an immediate- and 23 (4.9%) with a delayed-type reaction. Most frequently identified confirmed allergy was to penicillins (65 patients), followed by cephalosporins (21 patients). When immediate-type reactions were examined, NPV of skin tests were 96.3% and 100% for penicillins and cephalosporins, respectively. When delayed reactions were considered, NPV were 91.9 and 87.5% for penicillins and cephalosporins, respectively. Evaluation of the safety of skin tests according to the standardized procedure showed that systemic allergic reactions occurred in only 0.7% of skin tests and in 3.1% of drug challenges. Overall, our data indicate that only 18.3% of patients with a beta-lactam allergy label have a confirmed allergy and non-allergic patients can be safely delabeled through allergic workup based on skin tests and drug challenge. This approach supports the policy of saving second-line antibiotics through a standardized allergy workup. Frontiers Media S.A. 2022-04-08 /pmc/articles/PMC9234877/ /pubmed/35769578 http://dx.doi.org/10.3389/falgy.2022.853587 Text en Copyright © 2022 Iuliano, Senn, Moi, Muller, Ribi, Buss and Comte. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Allergy Iuliano, Sarah Senn, Laurence Moi, Laura Muller, Yannick D. Ribi, Camillo Buss, Guillaume Comte, Denis Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title | Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title_full | Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title_fullStr | Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title_full_unstemmed | Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title_short | Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study |
title_sort | management of beta-lactam antibiotics allergy: a real-life study |
topic | Allergy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234877/ https://www.ncbi.nlm.nih.gov/pubmed/35769578 http://dx.doi.org/10.3389/falgy.2022.853587 |
work_keys_str_mv | AT iulianosarah managementofbetalactamantibioticsallergyareallifestudy AT sennlaurence managementofbetalactamantibioticsallergyareallifestudy AT moilaura managementofbetalactamantibioticsallergyareallifestudy AT mulleryannickd managementofbetalactamantibioticsallergyareallifestudy AT ribicamillo managementofbetalactamantibioticsallergyareallifestudy AT bussguillaume managementofbetalactamantibioticsallergyareallifestudy AT comtedenis managementofbetalactamantibioticsallergyareallifestudy |