There do not appear to be consistent genetic markers to reliably predict features of or the presence hypersensitivity reactions. Recent evidence continues to alleviate early concerns cross-reactivity between sulfonamide antibiotics and non-antibiotics. Sulfonamide drug allergy is frequently encountered by the practicing clinician. For sulfonamide antibiotics, delayed rash is the most common clinical manifestation. There is no current evidence to support avoidance of all non-antibiotic sulfonamides in those with a reported allergy to sulfonamide antibiotics, although certain scenarios require caution. Available evidence supports the cautious reintroduction of sulfonamide antibiotics via desensitization, which is usually well tolerated and should be considered in those with strong indications for trimethoprim-sulfamethoxazole and a reported sulfonamide allergy.

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Febrile neutropenia leads to over 100,000 hospitalizations in the US each year and can cause sepsis, septic shock, and death. Although first-line treatment for neutropenic fever is an anti-Pseudomonal betalactam, >10%of patients report a beta-lactam allergy. Since 90% of patients with a documented beta-lactam allergy do not have true allergy, we assessed the association of documented beta-lactam allergy to first-line febrile neutropenia antibiotic treatment. METHODS: In this national cross-sectional study of hospitalized patients, we determined the relation of documented beta-lactam allergy (i.e. a penicillin and/or cephalosporin allergy in the electronic medical record) to first-line febrile neutropenia treatment (i.e., cefepime, anti-Pseudomonal carbapenem, or piperacillin-tazobactam), using Generalized Estimating Equations models with logit link adjusted for age, sex, race, intensive care unit location, and resistant organism colonization/infection. RESULTS: Of 290 inpatients with febrile neutropenia receiving antibiotics at 64 US hospitals, 55 (19%) patients had a documented beta-lactam allergy. Patients with a documented beta-lactam allergy less frequently received first-line treatment (36% vs 63%), with less frequent cefepime (36% vs 63%) and piperacillin-tazobactam (9% vs 15%) but more frequent meropenem (35% vs 11%). In the fully adjusted model, patients with a documented beta-lactam allergy had reduced use of first-line febrile neutropenia treatment (adjusted Odds Ratio [aOR] 0.36, 95%CI [0.20, 0.64]). CONCLUSIONS: In this national sample of patients with febrile neutropenia, a documented beta-lactam allergy was associated with a significant, 64%, decreased use of first-line antibiotic treatment. Improved systems for optimizing first-line beta-lactam use in patients with febrile neutropenia are needed to improve care in this high-risk patient population.