Adverse Reactions Associated with Therapeutic Antibiotic Use After Penicillin Skin Testing

Overview

Journal Perm J

Specialties General Medicine
Health Services

Date 2011 Aug 16

PMID 21841922

Citations 7

Authors

Eric Macy

Ngoc J Ho

Affiliations

Soon will be listed here.

Abstract

Background: There is little prospective data on the antibiotics prescribed and the adverse reactions associated with their use after penicillin skin testing.

Objective: Provide data on antibiotic use and new antibiotic "allergy" incidence after penicillin skin testing.

Methods: All patients who had penicillin skin testing at our Medical Center between 1-1-2000 and 12-31-2004 were followed through 12-31-2009. All therapeutic antibiotic use and all new "allergies" listed in their electronic medical records were reviewed.

Results: There were 1684 study subjects of whom 1191 (70.7%) were female. There were 118 (7.0%) positive to at least one penicillin skin test reagent and 3 (0.2%) were positive only to amoxicillin. The mean follow-up period was 4.5 ± 2.9 years. Subjects were exposed to a mean of 8.2 ± 10.5 therapeutic antibiotic courses during follow-up. The highest new antibiotic "allergy" incidence rates in skin test-negative subjects were noted for penicillins, 2.9%, and sulfonamides, 2.7%, p = 0.9097. Females had higher overall incidences of new antibiotic "allergy," independent of skin test result. Penicillin skin test-negative females treated with penicillin had a nonsignificantly higher new penicillin "allergy" incidence, 3.3% per course versus 1.9% for males, p = 0.0644. Cephalosporins had new antibiotic "allergy" incidence rates not significantly different from tetracyclines, quinolones, macrolides, clindamycin, metronidazole, nitrofurantoin, and other antibiotics.

Conclusions: Females had higher new antibiotic "allergy" incidence rates. New "allergy" to cephalosporins occurred no more frequently than with non-beta-lactam-antibiotics, independent of skin test result. Sulfonamide antibiotics were associated with the higher rates of new antibiotic "allergy" than cephalosporins.

Citing Articles

Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns.

Hills T, Arroll N, Duffy E, Capstick J, Jordan A, Fitzharris P Front Allergy. 2022; 1:586301.

PMID: 35386932 PMC: 8974713. DOI: 10.3389/falgy.2020.586301.

Evaluating Penicillin Allergies Without Skin Testing.

Banks T, Tucker M, Macy E Curr Allergy Asthma Rep. 2019; 19(5):27.

PMID: 30903298 DOI: 10.1007/s11882-019-0854-6.

Causality and preventability assessment of adverse drug reactions and adverse drug events of antibiotics among hospitalized patients: A multicenter, cross-sectional study in Lahore, Pakistan.

Iftikhar S, Sarwar M, Saqib A, Sarfraz M PLoS One. 2018; 13(6):e0199456.

PMID: 29949616 PMC: 6021047. DOI: 10.1371/journal.pone.0199456.

Causality and preventability assessment of adverse drug events of antibiotics among inpatients having different lengths of hospital stay: a multicenter, cross-sectional study in Lahore, Pakistan.

Saqib A, Sarwar M, Sarfraz M, Iftikhar S BMC Pharmacol Toxicol. 2018; 19(1):34.

PMID: 29941052 PMC: 6019808. DOI: 10.1186/s40360-018-0222-5.

Morbidity in Pregnant Women Associated with Unverified Penicillin Allergies, Antibiotic Use, and Group B Streptococcus Infections.

Desai S, Kaplan M, Chen Q, Macy E Perm J. 2017; 21:16-080.

PMID: 28333608 PMC: 5363897. DOI: 10.7812/TPP/16-080.

References

Park M, Koch C, Klemawesch P, Joshi A, Li J . Increased adverse drug reactions to cephalosporins in penicillin allergy patients with positive penicillin skin test. Int Arch Allergy Immunol. 2010; 153(3):268-73. DOI: 10.1159/000314367. View

Macy E, Schatz M, Lin C, Poon K . The falling rate of positive penicillin skin tests from 1995 to 2007. Perm J. 2011; 13(2):12-8. PMC: 3034425. DOI: 10.7812/TPP/08-073. View

Macy E, Poon K-Y T . Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med. 2009; 122(8):778.e1-7. DOI: 10.1016/j.amjmed.2009.01.034. View

Hershkovich J, Broides A, Kirjner L, Smith H, Gorodischer R . Beta lactam allergy and resensitization in children with suspected beta lactam allergy. Clin Exp Allergy. 2009; 39(5):726-30. DOI: 10.1111/j.1365-2222.2008.03180.x. View

Solensky R, Earl H, Gruchalla R . Lack of penicillin resensitization in patients with a history of penicillin allergy after receiving repeated penicillin courses. Arch Intern Med. 2002; 162(7):822-6. DOI: 10.1001/archinte.162.7.822. View

Lin E, Saxon A, Riedl M . Penicillin allergy: value of including amoxicillin as a determinant in penicillin skin testing. Int Arch Allergy Immunol. 2010; 152(4):313-8. DOI: 10.1159/000288284. View

Steinman M, Yang K, Byron S, Maselli J, Gonzales R . Variation in outpatient antibiotic prescribing in the United States. Am J Manag Care. 2009; 15(12):861-8. PMC: 2910590. View

Gilberg K, Laouri M, Wade S, Isonaka S . Analysis of medication use patterns:apparent overuse of antibiotics and underuse of prescription drugs for asthma, depression, and CHF. J Manag Care Pharm. 2003; 9(3):232-7. PMC: 10437266. DOI: 10.18553/jmcp.2003.9.3.232. View

Macy E, Burchette R . Oral antibiotic adverse reactions after penicillin skin testing: multi-year follow-up. Allergy. 2002; 57(12):1151-8. DOI: 10.1034/j.1398-9995.2002.23700.x. View

10.

Macy E, Goldberg B, Poon K . Use of commercial anti-penicillin IgE fluorometric enzyme immunoassays to diagnose penicillin allergy. Ann Allergy Asthma Immunol. 2010; 105(2):136-41. DOI: 10.1016/j.anai.2010.06.014. View

11.

Solensky R . Drug hypersensitivity. Med Clin North Am. 2005; 90(1):233-60. DOI: 10.1016/j.mcna.2005.08.010. View

12.

Park M, Matesic D, Markus P, Li J . Female sex as a risk factor for penicillin allergy. Ann Allergy Asthma Immunol. 2007; 99(1):54-8. DOI: 10.1016/S1081-1206(10)60621-7. View

13.

Bousquet P, Pipet A, Bousquet-Rouanet L, Demoly P . Oral challenges are needed in the diagnosis of beta-lactam hypersensitivity. Clin Exp Allergy. 2007; 38(1):185-90. DOI: 10.1111/j.1365-2222.2007.02867.x. View

14.

Schnyder B . Approach to the patient with drug allergy. Med Clin North Am. 2010; 94(4):665-79, xv. DOI: 10.1016/j.mcna.2010.03.006. View

15.

Apter A, Kinman J, Bilker W, Herlim M, Margolis D, Lautenbach E . Is there cross-reactivity between penicillins and cephalosporins?. Am J Med. 2006; 119(4):354.e11-9. DOI: 10.1016/j.amjmed.2005.10.052. View

16.

Macy E, Mangat R, Burchette R . Penicillin skin testing in advance of need: multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins. J Allergy Clin Immunol. 2003; 111(5):1111-5. DOI: 10.1067/mai.2003.1385. View

17.

Bittner A, Greenberger P . Incidence of resensitization after tolerating penicillin treatment in penicillin-allergic patients. Allergy Asthma Proc. 2004; 25(3):161-4. View

18.

Caubet J, Kaiser L, Lemaitre B, Fellay B, Gervaix A, Eigenmann P . The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol. 2010; 127(1):218-22. PMC: 7126001. DOI: 10.1016/j.jaci.2010.08.025. View

19.

DePestel D, Benninger M, Danziger L, LaPlante K, May C, Luskin A . Cephalosporin use in treatment of patients with penicillin allergies. J Am Pharm Assoc (2003). 2008; 48(4):530-40. DOI: 10.1331/JAPhA.2008.07006. View