Delabelling beta-lactam allergy

Abstract

Beta-lactam; Delabelling; Electronic medical records

Beta-lactámico; Desetiquetado; Registros médicos electrónicos

Betalactàmics; Desetiquetatge; Registres mèdics electrònics

Background: Hypersensitivity to beta-lactam (BL) antibiotics is one of the most frequent reported drug allergies. In our population, it is common to find labels of BL allergy in electronic medical records (EMRs) that have not been assessed. The objective of our study was to detect patients with beta-lactam allergy labels in their EMRs and to assess how many of them are false after a correct diagnostic evaluation. Methods: A multicentre prospective study was performed with patients labelled as allergic to BLs in their EMRs in the previous 5 years. Demographical and clinical data, as well as variables regarding the BL allergy label and the characteristics of the index reaction from clinical history and EMRs, were recorded. Then, diagnostic assessments including clinical history, skin tests (STs), and drug provocation tests (DPTs) were conducted in order to confirm or exclude the diagnosis of BL allergy. Results: A total of 249 patients completed the study, of which 160 (64.3%) were women with a median age of 57 years (interquartile range [IQR], 45–68). The most frequent BL allergy labels detected were for penicillin (124), amoxicillin/clavulanic acid (61), and amoxicillin (54). Of the 204 patients who underwent STs, 20.1% were positive. DPTs were performed in 224 patients, showing good tolerance in 87.1% of cases. After the allergy diagnosis work-up, 186 patients (74.7%) were diagnosed as non-allergic to BL antibiotics. Conclusion: In our study population, the number of patients labelled as allergic to BLs in their EMRs was similar to that in previously published studies, with proportions near to 75%–80% being falsely labelled as allergic to BLs.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by Instituto de Salud Carlos III through the project “PI19/01656” (co-funded by the European Regional Development Fund “A way to make Europe”). This payment was received by Hospital Universitari Vall d’Hebron and was used to the provide the material to the other participating centres, as well as to support data management, statistical analysis, and international diffusion in congresses and symposia of the results of the present study.