Comprehensive allergy work‐up is mandatory in cystic fibrosis patients who report a history suggestive of drug allergy to beta‐lactam antibiotics

Abstract

BackgroundIn the general population, reports on suspected ß-lactam hypersensitivity are common. After a drug allergy work-up at best 20% of the selected patients are positive. However, these considerations have not been explored in cystic fibrosis patients for whom antibiotics are even more crucial.MethodsThe study, part of the Drug Allergy and Hypersensitivity (DAHD) cohort, was performed in the regional cystic fibrosis center of Montpellier, France. After identifying patients with a clinical history suggestive of drug allergy to ß-lactams, a complete drug allergy work-up, was carried out according to the EAACI recommendations.ResultsAmong the 171 patients involved, 23 reported clinical manifestations potentially compatible with a drug allergy to ß-lactams. After performing the complete drug-allergy work-up, 7 were considered as drug hypersensitive (3 had positive skin tests, 1 a positive provocation test, 3 declined the tests). Excluding the latter 3 patients with incomplete drug allergy work-up, the rate of proven drug allergy was 2.3%.ConclusionsDrug allergy to ß-lactams in cystic fibrosis patients is of importance. A full drug allergy work-up is mandatory in case of suspicion, because ß-lactam responsibility is often ruled out.

Antimicrobial stewardshipʼs new weapon? A review of antibiotic allergy and pathways to ‘de-labeling’

“…In the majority, this was due to prescription of branded β-lactam combination products such as piperacillin–tazobactam (Tazocin) or amoxicillin–clavulanate (Augmentin), in which the trade name concealed the presence of penicillin [83]. A comprehensive allergy assessment reduces reported hypersensitivity labels and produces durable negative re-challenging responses [6 ▪▪ ]. Increased β-lactam use and decreased vancomycin and fluoroquinolone prescription have been demonstrated in inpatient and outpatient antibiotic SPT/IDT testing studies [14,84,85].…”

“…The consequences of an inappropriate antibiotic allergy label include limiting therapeutic options, increased broad-spectrum antibiotic use, increased risk of toxicity, and hospital costs [6 ▪▪ ,84–87]. A recent retrospective study by Charneski et al .…”

“…Imprecise antibiotic allergy labeling is associated with increased antibiotic costs, antimicrobial use, risk of acute care admission, and mortality [4,5 ▪ ]. Preliminary studies highlight an improvement in antibiotic utilization and patient outcomes with integrated in-vitro and in-vivo antibiotic allergy testing, re-challenging, de-labeling, and antimicrobial stewardship programs [6 ▪▪ ,7 ▪▪ ]. We review the current understanding of antibiotic allergy classification, pathogenesis, testing, and the impact of the antibiotic allergy label, and highlight the opportunity for integrated and proactive antimicrobial allergy, stewardship and decision support programs aimed at improving antibiotic prescribing and patient outcome.…”

Drug Allergy

“…Based on their initial results in the prospective study of 88 children with benign delayed cutaneous reactions during BL treatment (challenged irrespective of skin greater diagnostic value in confirming immediate rather than delayed-type DHR to BL, with a sensitivity ranging from 86% 46 for the former to 3.77% 55 for the latter. [56][57][58][59] Non-β-lactam Antibiotics Children suspected of having DHRs for antibiotics other than BL are not generally subjected to elective testing. 46,55 Some groups focussed on the use of specific BL in particular pediatric settings, i.e.…”

Report from the National Institute of Allergy and Infectious Diseases workshop on drug allergy

“…Recent publications reporting on the results of comprehensive evaluations for beta-lactam sensitivity have documented allergy in less than 3% of children with CF. (16, 17) This means that skin testing and oral challenge are both important tools to identify individuals with a true IgE allergic phenotype as the majority are tolerant and could be treated with a penicillin. Penicillin skin testing followed by oral challenge if the skin tests are negative is safe, but not all reagents necessary to evaluate beta-lactam allergy are available.…”