TY - JOUR
T1 - Controversies in Drug Allergy
T2 - Beta-Lactam Hypersensitivity Testing
AU - AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group
AU - Torres, Maria J.
AU - Adkinson, N. Franklin
AU - Caubet, Jean Christoph
AU - Khan, David A.
AU - Kidon, Mona I.
AU - Mendelson, Louis
AU - Gomes, Eva Rebelo
AU - Rerkpattanapipat, Ticha
AU - Zhang, Shuchen
AU - Macy, Eric
N1 - Funding Information:
Conflicts of interest: M. J. Torres receives research support from the Instituto de Salud Carlos III (ISCIII) cofounded by Fondo Europeo de Desarrollo Regional (FEDER) for the Thematic Networks and Co-operative Research Centres: ARADyAL (RD16/0006/0001) and the Andalusian Ministry of Health ; has been a speaker for Diater-Ferrer, Madrid, Spain; and has a patent licensed by Diater-Ferrer, Madrid, Spain. N. F. Adkinson Jr is an officer of and has equity ownership in AllerQuest, LLC, which manufactures and sells penicillin skin testing reagents. D. A. Khan has received speaker honoraria from Genentech; serves on an advisory board for Aimmune; and is an author for UpToDate. L. Mendelson is a stock holder and president of AllerQuest, LLC, the company that brought PrePen back to market. E. Macy is a partner with the Southern California Permanente Medical group; has received research grants from ALK, the sellers of PrePen; has served on data and safety monitoring boards for BioMarin, Tufts University, UltraGenyx, and Audentes; and has done consulting for BioMarin and KaloBios. The rest of the authors declare that they have no relevant conflicts of interest.
Funding Information:
Conflicts of interest: M. J. Torres receives research support from the Instituto de Salud Carlos III (ISCIII) cofounded by Fondo Europeo de Desarrollo Regional (FEDER) for the Thematic Networks and Co-operative Research Centres: ARADyAL (RD16/0006/0001) and the Andalusian Ministry of Health; has been a speaker for Diater-Ferrer, Madrid, Spain; and has a patent licensed by Diater-Ferrer, Madrid, Spain. N. F. Adkinson Jr is an officer of and has equity ownership in AllerQuest, LLC, which manufactures and sells penicillin skin testing reagents. D. A. Khan has received speaker honoraria from Genentech; serves on an advisory board for Aimmune; and is an author for UpToDate. L. Mendelson is a stock holder and president of AllerQuest, LLC, the company that brought PrePen back to market. E. Macy is a partner with the Southern California Permanente Medical group; has received research grants from ALK, the sellers of PrePen; has served on data and safety monitoring boards for BioMarin, Tufts University, UltraGenyx, and Audentes; and has done consulting for BioMarin and KaloBios. The rest of the authors declare that they have no relevant conflicts of interest.
Funding Information:
This article is one of a series of international consensus documents developed from the International Drug Allergy Symposium held at the Joint Congress of the American Academy of Allergy, Asthma & Immunology/World Allergy Organization on March 1, 2018, in Orlando, Florida, USA. The symposium was sponsored by The Journal of Allergy and Clinical Immunology, The Journal of Allergy and Clinical Immunology: In Practice, and The World Allergy Organization Journal and chaired by Mariana Castells, MD, PhD, and Pascal Demoly, MD, PhD.
Publisher Copyright:
© 2019 American Academy of Allergy, Asthma & Immunology
PY - 2019/1
Y1 - 2019/1
N2 - All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.
AB - All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.
KW - Allergy
KW - Beta-lactam
KW - Cephalosporin
KW - Challenge
KW - Drug provocation test
KW - Hypersensitivity
KW - IgE
KW - Penicillin
KW - Severe cutaneous adverse reaction
KW - Skin test
KW - T cell
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U2 - 10.1016/j.jaip.2018.07.051
DO - 10.1016/j.jaip.2018.07.051
M3 - Review article
C2 - 30245291
AN - SCOPUS:85053733875
SN - 2213-2198
VL - 7
SP - 40
EP - 45
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 1
ER -