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. 2024 Dec;52(6):2279-2286.
doi: 10.1007/s15010-024-02274-1. Epub 2024 Jun 21.

Implementation and outcomes of beta-lactam allergy management protocol at a comprehensive cancer center

Wonhee So  1   2 , Sohanabanu I Khalak  3 , Stephanie Ho  4 , Justine Abella Ross  4 , Sanjeet S Dadwal  5 , Alfredo G Puing  6 , Deepa D Nanayakkara  5 , Avneet Kaur  5 , Randy A Taplitz  5 , Jana K Dickter  5
Affiliations

Implementation and outcomes of beta-lactam allergy management protocol at a comprehensive cancer center

Wonhee So et al. Infection. 2024 Dec.

Erratum in

Abstract

Purpose: Beta-lactam allergy (BLA) is associated with increased broad-spectrum antibiotic (Br-ABX) use and worse clinical outcomes. We evaluated our hospital-wide BLA protocol (BLA-P) that used following categories: intolerance, low-risk, and high-risk.

Methods: Hospitalized adult patients with listed BLA during 10/2021-12/2022 were eligible. Exclusions were critically ill, surgical, hospice or comfort care, or non-verbal patients. Assessment was counted each time a pharmacist evaluated BLA. Interventions were no further action (high-risk allergy, patient refusal, unstable clinical status), updated allergy label, or delabeled. Delabeling was done either based on antibiotic history (direct-delabeling), or via test-dose challenge for low-risk patients. Br-ABX usage was compared in the unique delabeled patients: the empiric antibiotic use 90 days post-delabeling versus pre-delabeling using McNemar test (SPSS).

Results: A total of 700 assessments in 631 patients were identified. 441 assessments in 377 patients (median 63 years-old, 41% male, 50% hematological cancer) met inclusion criteria. The assessments revealed 9% intolerance, 55% low-risk, 23% high-risk and 13% unknown reaction. Interventions resulted in no further action 7%, updated label 72%, and delabeling 21%. 65% of the delabeling was via direct-delabeling and 35% test-dose challenge. Among patients who received a test-dose challenge, 36/36(97%) had no documented allergic reactions, and 1/26(3%) developed a mild rash. The use of aztreonam (pre-delabeling 28% vs. post-delabeling 1.2%, p < 0.001) and meropenem (13% vs. 2.4%, p = 0.022) significantly decreased while cefepime (24% vs. 50%, p = 0.001) and piperacillin-tazobactam (3.7% vs. 22%, p < 0.001) increased after delabeling.

Conclusion: BLA-P led to 21% delabeling, which resulted in increased preferred Br-ABX and decrease in aztreonam/meropenem use among delabeled patients.

Keywords: Allergy; Beta-lactam; Cancer; Delabeling; Test-dose challenge.

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Conflict of interest statement

Declarations. Conflict of interest: RAT serves in Karius and Merck Advisory boards. All authors have no relevant financial or non-financial interests to disclose.

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