Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing.
Torres MJAllergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Malaga, Spain; Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Malaga, Spain.
Adkinson NFAllergy & Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
Caubet JCPediatric Allergy Unit, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland.
Khan DADivision of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Kidon MIClinical Immunology, Angioedema and Allergy Unit, Chaim Sheba Medical Center, Pediatric Allergy Clinic, Safra Children's Hospital, Tel Hashomer, Ramat Gan, Israel; Faculty of Pediatric Medicine, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Mendelson LNew England Food Allergy Treatment Center, West Hartford, Conn.
Gomes ERAllergy and Clinical Immunology Department, Centro Hospitalar do Porto, Porto, Portugal.
Rerkpattanapipat TAllergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Zhang SDepartment of Allergy, Tongji Hospitals, Tongji Medical College of Huangzhong University of Science and Technology, Wuhan, China.
Macy EDepartment of Allergy, Southern California Permanente Medical Group, Kaiser Permanente San Diego Medical Center, San Diego, Calif. Electronic address: eric.m.macy@kp.org.
English
All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.