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. 2024 Jun 27:15:1423719.
doi: 10.3389/fphar.2024.1423719. eCollection 2024.

Delabelling beta-lactam allergy

Gustavo-Jorge Molina-Molina  1 , Diana Rocío Garnica Velandia  2   3 , Blanca Andrés-López  1 , Carolina Perales  4 , Laura Marin-Asensio  4 , Yanina Jurgens  5 , Olga Esteso  6 , Carolina Escobar  7 , Xavier Vidal  8   9 , Lourdes Vendrell  8   9   10 , Laura Gómez-Ganda  11 , Dolores Rodríguez  12 , Eva Montané  9   13 , Victoria Cardona  10   14 , Antònia Agustí  8   9
Affiliations

Delabelling beta-lactam allergy

Gustavo-Jorge Molina-Molina et al. Front Pharmacol. .

Abstract

Background: Hypersensitivity to beta-lactam (BL) antibiotics is one of the most frequent reported drug allergies. In our population, it is common to find labels of BL allergy in electronic medical records (EMRs) that have not been assessed. The objective of our study was to detect patients with beta-lactam allergy labels in their EMRs and to assess how many of them are false after a correct diagnostic evaluation. Methods: A multicentre prospective study was performed with patients labelled as allergic to BLs in their EMRs in the previous 5 years. Demographical and clinical data, as well as variables regarding the BL allergy label and the characteristics of the index reaction from clinical history and EMRs, were recorded. Then, diagnostic assessments including clinical history, skin tests (STs), and drug provocation tests (DPTs) were conducted in order to confirm or exclude the diagnosis of BL allergy. Results: A total of 249 patients completed the study, of which 160 (64.3%) were women with a median age of 57 years (interquartile range [IQR], 45-68). The most frequent BL allergy labels detected were for penicillin (124), amoxicillin/clavulanic acid (61), and amoxicillin (54). Of the 204 patients who underwent STs, 20.1% were positive. DPTs were performed in 224 patients, showing good tolerance in 87.1% of cases. After the allergy diagnosis work-up, 186 patients (74.7%) were diagnosed as non-allergic to BL antibiotics. Conclusion: In our study population, the number of patients labelled as allergic to BLs in their EMRs was similar to that in previously published studies, with proportions near to 75%-80% being falsely labelled as allergic to BLs.

Keywords: beta-lactam; delabelling; drug provocation test; electronic medical records; penicillin; skin test.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the distribution of patients labelled as allergic to BLs according to their reference hospital and the final inclusion in each centre.
FIGURE 2
FIGURE 2
ST and DPT results of all patients after their first assessment and re-evaluation 4 weeks later.
FIGURE 3
FIGURE 3
(A) Number of allergic patients according to the age at the time of the index reaction. (B) Number of allergic patients according to the time passed since the onset of the index reaction.
FIGURE 4
FIGURE 4
(A) Predicted probability of being diagnosed as allergic according to the time passed since the index reaction. (B) Reduction in the proportion of allergic patients according to the time passed since the index reaction. (C) Reduction in the proportion of allergic patients according to the culprit drug since the index reaction. Figure 4A: In blue, the probability predicted by the logistic regression model, which estimates the OR of 0.56, is represented, with the 95% confidence bands; in red, the observed values.
See this image and copyright information in PMC

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