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Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing.
Journal article

Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing.

  • Torres MJ Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Malaga, Spain; Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Malaga, Spain.
  • Adkinson NF Allergy & Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
  • Caubet JC Pediatric Allergy Unit, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland.
  • Khan DA Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
  • Kidon MI Clinical 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 L New England Food Allergy Treatment Center, West Hartford, Conn.
  • Gomes ER Allergy and Clinical Immunology Department, Centro Hospitalar do Porto, Porto, Portugal.
  • Rerkpattanapipat T Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
  • Zhang S Department of Allergy, Tongji Hospitals, Tongji Medical College of Huangzhong University of Science and Technology, Wuhan, China.
  • Macy E Department of Allergy, Southern California Permanente Medical Group, Kaiser Permanente San Diego Medical Center, San Diego, Calif. Electronic address: eric.m.macy@kp.org.
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  • 2018-09-25
Published in:
  • The journal of allergy and clinical immunology. In practice. - 2019
Allergy
Beta-lactam
Cephalosporin
Challenge
Drug provocation test
Hypersensitivity
IgE
Penicillin
Severe cutaneous adverse reaction
Skin test
T cell
Allergens
Anti-Bacterial Agents
Consensus
Drug Hypersensitivity
Humans
Hypersensitivity, Immediate
Immune Tolerance
Patient Acceptance of Health Care
Skin Tests
beta-Lactams
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.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/46683
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