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Ben Fadhel N, Aroua F, Chadli Z, et al. Betalactam hypersensitivity: The importance of delabelling in primary care. Br J Clin Pharmacol. 2021;87(12):4619-4624doi: 10.1111/bcp.14879.
Ben Fadhel, N., Aroua, F., Chadli, Z., Ben Romdhane, H., Chaabane, A., Sahtout, M., Boughattas, N. A., Ben Fredj, N., & Aouam, K. (2021). Betalactam hypersensitivity: The importance of delabelling in primary care. British journal of clinical pharmacology, 87(12), 4619-4624. https://doi.org/10.1111/bcp.14879
Ben Fadhel, Najah, et al. "Betalactam hypersensitivity: The importance of delabelling in primary care." British journal of clinical pharmacology vol. 87,12 (2021): 4619-4624. doi: https://doi.org/10.1111/bcp.14879
Ben Fadhel N, Aroua F, Chadli Z, Ben Romdhane H, Chaabane A, Sahtout M, Boughattas NA, Ben Fredj N, Aouam K. Betalactam hypersensitivity: The importance of delabelling in primary care. Br J Clin Pharmacol. 2021 Dec;87(12):4619-4624. doi: 10.1111/bcp.14879. Epub 2021 May 14. PMID: 33899257.
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Br J Clin Pharmacol. 2021 Dec;87(12):4619-4624. doi: 10.1111/bcp.14879. Epub 2021 May 14.

Betalactam hypersensitivity: The importance of delabelling in primary care.

British journal of clinical pharmacology

Najah Ben Fadhel, Fares Aroua, Zohra Chadli, Haifa Ben Romdhane, Amel Chaabane, Mounira Sahtout, Naceur A Boughattas, Nadia Ben Fredj, Karim Aouam

Affiliations

  1. Department of Pharmacology, University Hospital of Fattouma Bourguiba Monastir, Tunisia.
  2. Primary Care of Medicine in Monastir, Tunisia.

PMID: 33899257 DOI: 10.1111/bcp.14879

Abstract

PATIENTS AND METHODS: An allergy work-up was performed on adult patients with a history of a penicillin allergy seen by primary medical care in Monastir (Tunisia) between July 2016 and February 2018. Patients with negative skin tests were challenged with amoxicillin. Patients who were delabelled were contacted by phone after 6 months to determine outcomes after any therapeutic penicillin-class antibiotic intake.

RESULTS: A total of 39 patients were evaluated and 33 (84.6%) were delabelled. Five patients were penicillin skin-test positive and one was oral challenge positive. We succeeded in contacting 33 delabelled patients at 6 months. Twenty-two patients tolerated a subsequent therapeutic course of amoxicillin, eight patients did not retake penicillin due to a lack of therapeutic indication, and three patients refused an indicated penicillin use fearful of another reaction.

CONCLUSION: This study highlights the importance of allergy work-up in the diagnosis of beta-lactam hypersensitivity. Most patients were excessively labelled as beta-lactam allergic and this mislabelling could increase healthcare costs and lead to the development of drug resistance by the use of wide-spectrum antibiotics.

© 2021 British Pharmacological Society.

Keywords: betalactams hypersensitivity; challenge test; drug delabling; drug hypersensitivity; skin tests

References

  1. Solensky R. The time for penicillin skin testing is here. J Allergy Clin Immunol Pract. 2013;1(3):264-265. - PubMed
  2. Macy E. Penicillin and beta-lactam allergy: epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14:476. https://pubmed.ncbi.nlm.nih.gov/25216741/ - PubMed
  3. Har D, Solensky R. Penicillin and beta-lactam hypersensitivity. Immunol Allergy Clin North Am. 2017;37(4):643-662. - PubMed
  4. Salden OAE, Rockmann H, Verheij TJM, Broekhuizen BDL. Diagnosis of allergy against beta-lactams in primary care: prevalence and diagnostic criteria. Fam Pract. 2015;32(3):257-262. - PubMed
  5. Wu JH, Langford BJ, Schwartz KL, et al. Potential negative effects of antimicrobial allergy labelling on patient care: a systematic review. Can J Hosp Pharm. 2018;71(1):29-35. - PubMed
  6. Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK. Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ. 2018;361:k2400. - PubMed
  7. Caubet J-C, Kaiser L, Lemaître B, Fellay B, Gervaix A, Eigenmann PA. The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol. 2011;127(1):218-222. - PubMed
  8. Ponvert C, Perrin Y, Bados-Albiero A, et al. Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol off Publ Eur Soc Pediatr Allergy Immunol. 2011;22(4):411-418. - PubMed
  9. Solensky R, Jacobs J, Lester M, et al. Penicillin allergy evaluation: a prospective, multicenter, open-label evaluation of a comprehensive penicillin skin test kit. J Allergy Clin Immunol Pract. 2019;7(6):1876-1885.e3. - PubMed
  10. Brockow K, Garvey LH, Aberer W, et al. Skin test concentrations for systemically administered drugs - an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702-712. - PubMed
  11. Macy E, Ngor EW. Safely diagnosing clinically significant penicillin allergy using only penicilloyl-poly-lysine, penicillin, and oral amoxicillin. J Allergy Clin Immunol Pract. 2013;1(3):258-263. - PubMed
  12. Chiriac A-M, Rerkpattanapipat T, Bousquet P-J, Molinari N, Demoly P. Optimal step doses for drug provocation tests to prove beta-lactam hypersensitivity. Allergy Avr. 2017;72(4):552-561. - PubMed
  13. Picard M, Bégin P, Bouchard H, et al. Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital. J Allergy Clin Immunol Pract. 2013;1(3):252-257. - PubMed
  14. Mohamed OE, Beck S, Huissoon A, et al. A retrospective critical analysis and risk stratification of penicillin allergy delabeling in a UK specialist regional allergy service. J Allergy Clin Immunol Pract. 2019;7(1):251-258. - PubMed
  15. Blanca-López N, Zapatero L, Alonso E, et al. Skin testing and drug provocation in the diagnosis of nonimmediate reactions to aminopenicillins in children. Allergy. 2009;64(2):229-233. - PubMed
  16. Caubet J-C, Frossard C, Fellay B, Eigenmann PA. Skin tests and in vitro allergy tests have a poor diagnostic value for benign skin rashes due to β-lactams in children. Pediatr Allergy Immunol off Publ Eur Soc Pediatr Allergy Immunol févr. 2015;26(1):80-82. - PubMed
  17. Jaoui A, Delalande D, Siouti S, et al. Safety and cost effectiveness of supervised ambulatory drug provocation tests in children with mild non-immediate reactions to beta-lactams. Allergy déc. 2019;74(12):2482-2484. - PubMed
  18. Amsler E, Soria A. Hypersensitivity reactions to beta-lactam antibiotics. Rev Med Interne. 2017;38(11):737-748. - PubMed
  19. Chen JR, Tarver SA, Alvarez KS, Tran T, Khan DA. A proactive approach to penicillin allergy testing in hospitalized patients. J Allergy Clin Immunol Pract. 2017;5(3):686-693. - PubMed
  20. Moussa Y, Shuster J, Matte G, et al. De-labeling of β-lactam allergy reduces intraoperative time and optimizes choice in antibiotic prophylaxis. Surgery. 2018;164(1):117-123. - PubMed
  21. Bourke J, Pavlos R, James I, Phillips E. Improving the effectiveness of penicillin allergy de-labeling. J Allergy Clin Immunol Pract. 2015;3(3):365-374.e1. - PubMed
  22. Gerace KS, Phillips E. Penicillin allergy label persists despite negative testing. J Allergy Clin Immunol Pract Oct. 2015;3(5):815-816. - PubMed
  23. Martinez Tadeo JA, Perez Rodriguez E, Almeida Sanchez Z, Callero Viera A, Garcia Robaina JC. No cross-reactivity with cephalosporins in patients with penicillin allergy. J Investig Allergol Clin Immunol. 2015;25(3):216-217. - PubMed
  24. Blanca M, Romano A, Torres MJ, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy févr. 2009;64(2):183-193. - PubMed
  25. Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol--Head Neck Surg off J Am Acad Otolaryngol-Head Neck Surg. 2007;136(3):340-347. - PubMed
  26. Harandian F, Pham D, Ben-Shoshan M. Positive penicillin allergy testing results: a systematic review and meta-analysis of papers published from 2010 through 2015. Postgrad Med août. 2016;128(6):557-562. - PubMed
  27. Moral L, Garde J, Toral T, Fuentes MJ, Marco N. Short protocol for the study of paediatric patients with suspected betalactam antibiotic hypersensitivity and low risk criteria. Allergol Immunopathol (Madr). 2011;39(6):337-341. - PubMed
  28. Regateiro FS, Rezende I, Pinto N, Abreu C, Carreiro-Martins P, Gomes ER. Short and extended provocation tests have similar negative predictive value in non-immediate hypersensitivity to beta-lactams in children. Allergol Immunopathol Madr. 2019;47(5):477-483. - PubMed
  29. Graham F, Tsabouri S, Caubet J-C. Hypersensitivity reactions to beta-lactams in children. Curr Opin Allergy Clin Immunol août. 2018;18(4):284-290. - PubMed
  30. Lachover-Roth I, Sharon S, Rosman Y, Meir-Shafrir K, Confino-Cohen R. Long-term follow-up after penicillin allergy delabeling in ambulatory patients. J Allergy Clin Immunol Pract. 2019;7(1):231-235.e1. - PubMed
  31. Al-Ahmad M, Rodriguez-Bouza T. Drug allergy evaluation for betalactam hypersensitivity: cross-reactivity with cephalosporines, carbapenems and negative predictive value. Asian Pac J Allergy Immunol Mars. 2018;36(1):27-31. - PubMed
  32. Celik G, Aydın Ö, Dogu F, et al. Diagnosis of immediate hypersensitivity to β-lactam antibiotics can be made safely with current approaches. Int Arch Allergy Immunol. 2011;157:311-317. - PubMed
  33. Macy E, Burchette RJ. Oral antibiotic adverse reactions after penicillin skin testing: multi-year follow-up. Allergy. 2002;57(12):1151-1158. - PubMed

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