Management of patients with suspected or confirmed antibiotic allergy. Executive summary of guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

A retrospective case-control study to evaluate the use of beta-lactam desensitization in the management of penicillin-allergic patients: a potential strategy for Antimicrobial Stewardship Programs

“…While we are aware that it would be ideal to confirm allergy prior to desensitization, there are also certain differences between countries in terms of accessibility to allergists ( Paño-Pardo et al, 2022 ), and in the context of a life-threatening infection where the patient is unstable, a full allergy anamnesis is difficult to make. If it is not possible to carry out a thorough allergy evaluation at the time, desensitization is justified even when the allergy label cannot be confirmed, especially in patients with serious and active life-threatening infections, to avoid delaying beta-lactam administration if the patient can realistically benefit from it for the treatment of their infection ( Shenoy et al, 2019 ; Paño-Pardo et al, 2022 ). Although a good attempt was made to adjust fully for few covariates, the final number of events was low, which restricts the accuracy of some estimates.…”

“…An Infectious Diseases physician prescribed desensitization in selected patients. The selection was made from patients with severe or life-threatening infections for whom the physician considered that alternative treatment was not available or was suboptimal and could compromise the patient’s life expectancy due to the source of infection (e.g., central nervous system) or microbiology ( Shenoy et al, 2019 ; Paño-Pardo et al, 2022 ). In addition, these patients had to meet one of the following criteria: a) patients with confirmed allergy and the results of previous skin tests positive for penicillin; b) a history of immediate hypersensitivity reactions (including anaphylactic reaction); c) PAL with unconfirmed hypersensitivity, but in a compromised clinical situation and in need of penicillin or a penicillin-related antibiotic ( Shenoy et al, 2019 ).…”

“…There are some strategies available to remove an allergy label, such as skin tests and oral provocation, as well as obtaining a complete allergy history ( Trubiano et al, 2016 ; Trubiano et al, 2017a ; Trubiano et al, 2017b ; Rose et al, 2020 ; Stone et al, 2020 ). Although less widespread, antibiotic desensitization is an option in patients with confirmed or high-risk penicillin allergy ( Habib et al, 2015 ; Paño-Pardo et al, 2022 ; Rodríguez-Alarcón et al, 2022 ). The mechanism of desensitization is to induce tolerance to the drug by administering increasing concentrations of the diluted antibiotic and to prevent anaphylaxis due to inhibition of IgE cross-linking and mast cell degranulation.…”