Is the Anamnesis Enough to De-Label Patients with Reported Beta-Lactam Allergy?

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Dec 17

PMID 39685725

Authors

Lesia Rozlucka

Barbara Rymarczyk

Radoslaw Gawlik

Joanna Gluck

Affiliations

Soon will be listed here.

Abstract

The decision whether to de-label patient with suspected BL hypersensitivity is based on risk stratification. The aim of this study was to prepare a characteristic of diagnostic risk groups and to create a model enabling the identification of the low-risk diagnostic group. We analyzed the medical records of patients hospitalized due to suspected hypersensitivity to BL antibiotics. Based on their medical-history data, patients were divided into three diagnostic risk groups, using the criteria proposed by Shenoy et al. Univariate and multivariate analysis models were used to create a diagnostic tool. Among 263 patients referred for BL hypersensitivity diagnosis, 88 (33.5%) were allocated to group I, 129 (49%) to group II, and 46 (17.5%) to group III. There were significant differences between diagnostic risk groups regarding history of hypersensitivity to penicillins ( < 0.001), cephalosporins ( < 0.001), >1 BL ( < 0.05), several episodes of BL hypersensitivity ( < 0.001), medical intervention ( < 0.001), documented hypersensitivity ( < 0.001), time from drug intake to symptoms ( < 0.001), and time from hypersensitivity to diagnosis ( < 0.001). In total, 81 patients (30.8%) were de-labeled: 52 (59.8%) in group I, 27 (20.9%) in group II, and 2 (4.3%) in group III. The univariate analysis model of the low-diagnostic-risk group applied to the de-labeled part showed 90% specificity and 21.93% sensitivity. NPV and PPV were estimated at 72.04% and 49.53%, respectively. The multivariate model had high specificity but low sensitivity; its NPV was 76%, with 68% PPV. The tool enabling the identification of low-diagnostic-risk patients based on anamnesis is not sensitive enough to de-label patients on its basis.

References

Dhopeshwarkar N, Sheikh A, Doan R, Topaz M, Bates D, Blumenthal K . Drug-Induced Anaphylaxis Documented in Electronic Health Records. J Allergy Clin Immunol Pract. 2018; 7(1):103-111. PMC: 6311439. DOI: 10.1016/j.jaip.2018.06.010. View

Blumenthal K, Huebner E, Fu X, Li Y, Bhattacharya G, Levin A . Risk-based pathway for outpatient penicillin allergy evaluations. J Allergy Clin Immunol Pract. 2019; 7(7):2411-2414.e1. PMC: 6733651. DOI: 10.1016/j.jaip.2019.04.006. View

Koo G, Yu R, Phillips E, Stone Jr C . Retrospective stratification of cephalosporin allergy label risk using validated penicillin allergy frameworks. J Allergy Clin Immunol Pract. 2022; 10(9):2472-2475.e1. DOI: 10.1016/j.jaip.2022.05.032. View

Wells D, DeNiro K, Ramsey A . Telemedicine in Drug Hypersensitivity. Immunol Allergy Clin North Am. 2022; 42(2):323-333. DOI: 10.1016/j.iac.2021.12.007. View

Romano A, Gaeta F, Valluzzi R, Maggioletti M, Zaffiro A, Caruso C . IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol. 2015; 136(3):685-691.e3. DOI: 10.1016/j.jaci.2015.03.012. View

Devchand M, Urbancic K, Khumra S, Douglas A, Smibert O, Cohen E . Pathways to improved antibiotic allergy and antimicrobial stewardship practice: The validation of a beta-lactam antibiotic allergy assessment tool. J Allergy Clin Immunol Pract. 2018; 7(3):1063-1065.e5. PMC: 6395557. DOI: 10.1016/j.jaip.2018.07.048. View

Piotin A, Godet J, Trubiano J, Grandbastien M, Guenard-Bilbault L, de Blay F . Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule. Ann Allergy Asthma Immunol. 2021; 128(1):27-32. DOI: 10.1016/j.anai.2021.07.005. View

Soria A, Autegarden E, Amsler E, Gaouar H, Vial A, Frances C . A clinical decision-making algorithm for penicillin allergy. Ann Med. 2017; 49(8):710-717. DOI: 10.1080/07853890.2017.1370125. View

Phillips E, Demoly P, Torres M . Addressing beta-lactam allergy: A time for action. Allergy. 2022; 77(4):1091-1093. DOI: 10.1111/all.15135. View

10.

Chiriac A, Wang Y, Schrijvers R, Jean Bousquet P, Mura T, Molinari N . Designing Predictive Models for Beta-Lactam Allergy Using the Drug Allergy and Hypersensitivity Database. J Allergy Clin Immunol Pract. 2017; 6(1):139-148.e2. DOI: 10.1016/j.jaip.2017.04.045. View

11.

Li M, Krishna M, Razaq S, Pillay D . A real-time prospective evaluation of clinical pharmaco-economic impact of diagnostic label of 'penicillin allergy' in a UK teaching hospital. J Clin Pathol. 2014; 67(12):1088-92. DOI: 10.1136/jclinpath-2014-202438. View

12.

Shenoy E, Macy E, Rowe T, Blumenthal K . Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019; 321(2):188-199. DOI: 10.1001/jama.2018.19283. View

13.

Torres M, Blanca M, Fernandez J, Romano A, Weck A, Aberer W . Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy. 2003; 58(10):961-72. DOI: 10.1034/j.1398-9995.2003.00280.x. View

14.

Albin S, Agarwal S . Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population. Allergy Asthma Proc. 2015; 35(6):489-94. PMC: 4210656. DOI: 10.2500/aap.2014.35.3791. View

15.

Romano A, Atanaskovic-Markovic M, Barbaud A, Bircher A, Brockow K, Caubet J . Towards a more precise diagnosis of hypersensitivity to beta-lactams - an EAACI position paper. Allergy. 2019; 75(6):1300-1315. DOI: 10.1111/all.14122. View

16.

Macy E, Contreras R . Adverse reactions associated with oral and parenteral use of cephalosporins: A retrospective population-based analysis. J Allergy Clin Immunol. 2014; 135(3):745-52.e5. DOI: 10.1016/j.jaci.2014.07.062. View

17.

Stone Jr C, Stollings J, Lindsell C, Dear M, Buie R, Rice T . Risk-stratified Management to Remove Low-Risk Penicillin Allergy Labels in the ICU. Am J Respir Crit Care Med. 2020; 201(12):1572-1575. PMC: 7301733. DOI: 10.1164/rccm.202001-0089LE. View

18.

Park C, Yang M, Kang D, Park H, Park S, Nam Y . Risk factors of beta-lactam anaphylaxis in Korea: A 6-year multicenter retrospective adult case-control study. World Allergy Organ J. 2021; 14(9):100580. PMC: 8433252. DOI: 10.1016/j.waojou.2021.100580. View

19.

Devchand M, Kirkpatrick C, Stevenson W, Garrett K, Perera D, Khumra S . Evaluation of a pharmacist-led penicillin allergy de-labelling ward round: a novel antimicrobial stewardship intervention. J Antimicrob Chemother. 2019; 74(6):1725-1730. DOI: 10.1093/jac/dkz082. View

20.

Jagpal P, AlShareef S, Marriott J, Krishna M . Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review. Clin Transl Allergy. 2022; 12(8):e12190. PMC: 9395947. DOI: 10.1002/clt2.12190. View