β-Lactam allergy testing and delabeling-Experiences and lessons from Singapore
© 2020 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd..
BACKGROUND: β-Lactam allergy is over-reported and this leads to greater healthcare costs. Allergy testing has inherent risks, yet patients who test negative may continue avoiding β-lactams.
OBJECTIVE: To evaluate the safety and diagnostic value of β-lactams allergy testing locally and usage of antibiotics following negative testing.
METHODS: We performed a retrospective medical record review and follow-up survey of patients who underwent β-lactam testing between 2010 and 2016 at the National Skin Centre, Singapore.
RESULTS: We reviewed the records of 166 patients, with a total of 173 β-lactam allergy labels. Eighty (46.2%) labels were to penicillin, 75 (43.1%) to amoxicillin/amoxicillin-clavulanic acid, 11 (6.4%) to cephalexin, and 5 (2.9%) to others. Skin tests were performed in 142 patients and drug provocation tests (DPTs) in 141 patients. Eleven (6.6%) patients defaulted DPTs after skin testing. Out of 166 patients, 22 (13.3%) patients were proven allergic by either skin tests (16) or DPTs (6). Patients who tested positive had nonsevere reactions. Out of 155 patients who were conclusively evaluated, 133 (85.8%) were not allergic. Of these patients, 30 (22.6%) used the tested β-lactam subsequently, with one reporting a mild reaction. Fifty-one (38.3%) patients were uncontactable or uncertain if they consumed a β-lactam since testing negative. Fifty-two (39.1%) patients had no re-exposure (35 had no indication, 17 were fearful of reactions).
CONCLUSION: Drug allergy testing was safe and removed inappropriate labels.
CLINICAL IMPLICATION: Allergy testing is efficacious, but fears of subsequent rechallenge should be addressed to maximize the effectiveness of allergy delabeling.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
Immunity, inflammation and disease - 8(2020), 3 vom: 17. Sept., Seite 371-379 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Heng, Yee Kiat [VerfasserIn] |
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| Links: |
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| Themen: |
β-lactam |
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| Anmerkungen: |
Date Completed 21.09.2021 Date Revised 21.09.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/iid3.318 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM310863155 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: β-Lactam allergy is over-reported and this leads to greater healthcare costs. Allergy testing has inherent risks, yet patients who test negative may continue avoiding β-lactams | ||
| 520 | |a OBJECTIVE: To evaluate the safety and diagnostic value of β-lactams allergy testing locally and usage of antibiotics following negative testing | ||
| 520 | |a METHODS: We performed a retrospective medical record review and follow-up survey of patients who underwent β-lactam testing between 2010 and 2016 at the National Skin Centre, Singapore | ||
| 520 | |a RESULTS: We reviewed the records of 166 patients, with a total of 173 β-lactam allergy labels. Eighty (46.2%) labels were to penicillin, 75 (43.1%) to amoxicillin/amoxicillin-clavulanic acid, 11 (6.4%) to cephalexin, and 5 (2.9%) to others. Skin tests were performed in 142 patients and drug provocation tests (DPTs) in 141 patients. Eleven (6.6%) patients defaulted DPTs after skin testing. Out of 166 patients, 22 (13.3%) patients were proven allergic by either skin tests (16) or DPTs (6). Patients who tested positive had nonsevere reactions. Out of 155 patients who were conclusively evaluated, 133 (85.8%) were not allergic. Of these patients, 30 (22.6%) used the tested β-lactam subsequently, with one reporting a mild reaction. Fifty-one (38.3%) patients were uncontactable or uncertain if they consumed a β-lactam since testing negative. Fifty-two (39.1%) patients had no re-exposure (35 had no indication, 17 were fearful of reactions) | ||
| 520 | |a CONCLUSION: Drug allergy testing was safe and removed inappropriate labels | ||
| 520 | |a CLINICAL IMPLICATION: Allergy testing is efficacious, but fears of subsequent rechallenge should be addressed to maximize the effectiveness of allergy delabeling | ||
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| 700 | 1 | |a Kong, Yan Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Yen Loo |e verfasserin |4 aut | |
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