Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing

Torres, Maria J; Adkinson, N Franklin (Jr); Caubet, Jean-Christoph Roger J-P; Khan, David A; Kidon, Mona I; Mendelson, Louis; Gomes, Eva Rebelo; Rerkpattanapipat, Ticha; Zhang, Shuchen; Macy, Eric

doi:10.1016/j.jaip.2018.07.051

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Title		Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing
Authors		Torres, Maria J Adkinson, N Franklin (Jr) Caubet, Jean-Christoph Roger J-P Khan, David A Kidon, Mona I Mendelson, Louis Gomes, Eva Rebelo Rerkpattanapipat, Ticha Zhang, Shuchen Macy, Eric show all authors [1 - 10]
Collaboration		AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group
Published in		The Journal of Allergy and Clinical Immunology: In Practice. 2019, vol. 7, no. 1, p. 40-45
Abstract		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.
Keywords		Allergy — Beta-lactam — Cephalosporin — Challenge — Drug provocation test — Hypersensitivity — IgE — Penicillin — Skin — Test — Severe cutaneous adverse reaction — T cell
Identifiers		DOI: 10.1016/j.jaip.2018.07.051 PMID: 30245291
Full text		Article (Published version) (238 Kb) - Limited access to UNIGE Other version: https://www.sciencedirect.com/science/article/pii/S2213219818305518
Structures		Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique
Research group		Pathogenèse et traitement des allergies alimentaires (191)
Citation (ISO format)		TORRES, Maria J et al. Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing. In: The Journal of Allergy and Clinical Immunology: In Practice, 2019, vol. 7, n° 1, p. 40-45. doi: 10.1016/j.jaip.2018.07.051 https://archive-ouverte.unige.ch/unige:136369