Antibiotic allergy labels in immunocompromised populations

Abstract

Antibiotic allergy labels (AALs) are commonly reported, with well‐defined prevalence in the general population; several studies have now focused efforts on immunocompromised hosts. Understanding the prevalence of reported allergy labels and methods of antibiotic allergy evaluation and delabeling strategies has the potential to improve prescribing practices and clinical outcomes in this high‐antibiotic use group. In this review, we will discuss the current literature on the prevalence, impact, and evaluations of AALs in immunocompromised hosts with a focus on beta‐lactam (penicillin) allergy and sulfa‐antibiotic (antimicrobial sulfurs) allergy labels.

Delabelling multiple antibiotic allergy: Practical issues

“…The positive impact of delabelling incorrect penicillin allergy labels have shown to be especially pronounced among susceptible populations such as the immunocompromised and elderly ( 37 – 40 ). Similar benefits have been observed upon delabelling of other non-penicillin antibiotics such as sulfa-antibiotics ( 41 , 42 ). Although prospective data remains limited, the compound benefits following the delabelling of multiple antibiotic allergies will undoubtedly be exponential.…”

Bring it on again: antimicrobial stewardship in transplant infectious diseases: updates and new challenges

“…True rates of penicillin allergy are low. 45 Even in pre-lung transplant candidates with low lung volumes, PAST was well tolerated with no reported adverse events. 46 Studies of PAST demonstrated that up to 95% were successfully delabeled from their BLA, and subsequently, penicillins were safely administered in 51% of patients.…”

“…47,48 Sulfa allergy, reported in 5%-11% of immunocompromised patients, has important implications as sulfonamides are commonly prescribed for prophylaxis against opportunistic infections including Pneumocystis jiroveci and toxoplasmosis. 40,45 One study described a protocol-driven approach for SOT patients and found that among 52 patients with reported non-anaphylactic reaction to sulfa medications, 92% successfully completed a desensitization protocol. 49 Among them, 80% continued to tolerate sulfamethoxazole-trimethoprim >3 months later without adverse events, resulting in an estimated cost savings of $575 per desensitized patient.…”