Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients

Background: Drug allergies (DA) are immunologically mediated adverse drug reactions and their manifestations depend on a variety of drug- and patient-specific factors. The dysregulated immune system underpinning rheumatological diseases may also lead to an increase in hypersensitivity reactions, including DA. The higher prevalence of reported DA, especially anti-microbials, also restricts the medication repertoire for these already immunocompromised patients. However, few studies have examined the prevalence and impact of reported DA in this group of patients. Methods: Patients with a diagnosis of rheumatoid arthritis (RA), spondyloarthritis (SpA), or systemic lupus erythematosus (SLE) were recruited from the rheumatology clinics in a tertiary referral hospital between 2018 and 2019. Prevalence and clinical outcomes of reported DA among different rheumatological diseases were calculated and compared to a cohort of hospitalized non-rheumatology patients within the same period. Results: A total of 6081 patients (2541 rheumatology patients: 1286 RA, 759 SpA, and 496 SLE; and 3540 controls) were included. DA was more frequently reported among rheumatology patients compared to controls (23.8% vs. 13.8%, p < 0.01). Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were the two most commonly reported categories of DA with a prevalence of 12.0% and 5.1%, respectively. Reported antibiotics allergies were more frequent in patients with RA (OR = 1.20, 95% CI = 1.02–1.62, p = 0.03) and SLE (OR = 4.69, 95% CI = 3.69–5.95, p < 0.01); and associated with increased infection-related admissions among rheumatology patients (OR = 1.79, 95% CI = 1.09–2.95, p = 0.02). Among the subgroup of patients referred for allergy testing, 85.7% of beta-lactam antibiotic allergy labels were found to be inaccurate and de-labelled after negative drug provocation testing. Conclusion: The prevalence of reported DA was significantly higher in rheumatology patients. Reported antibiotic allergy was associated with increased rate of infection-related admissions. However, the rate of genuine antibiotic allergy was low. Further studies are needed to guide proper assessment of reported DA and impact of comprehensive allergy testing in this group of patients.

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Matched Case-Control Study of the Long-Term Impact of Beta-Lactam Antibiotic Allergy Testing

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01823-20 ◽

2020 ◽

Vol 64 (12) ◽

Author(s):

Jason A. Trubiano ◽

Nada Marhoon ◽

Sara Vogrin ◽

Kyra Y. L. Chua ◽

Natasha E. Holmes

Keyword(s):

Case Control Study ◽

Case Control ◽

Beta Lactam ◽

Allergy Testing ◽

Antibiotic Allergy ◽

Lactam Antibiotic ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

ABSTRACT Whereas the short-term impacts of antibiotic allergy testing on delabeling and antibiotic usage have been demonstrated, the long-term impacts have been less well defined. In a single-center matched case-control study from Melbourne, Australia, we demonstrate that a beta-lactam antibiotic allergy testing program has a significant impact on antibiotic usage and infection-related outcomes. This study supports implementation of an antibiotic allergy testing program as a standard of care of antimicrobial stewardship programs.

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Suspected penicillin allergy: risk assessment using an algorithm as an antibiotic stewardship project

Allergo Journal International ◽

10.1007/s40629-020-00135-5 ◽

2020 ◽

Vol 29 (6) ◽

pp. 174-180

Author(s):

Christiane Querbach ◽

Tilo Biedermann ◽

Dirk H. Busch ◽

Rüdiger Eisenhart-Rothe ◽

Susanne Feihl ◽

...

Keyword(s):

Risk Stratification ◽

Bacterial Infections ◽

University Hospital ◽

Beta Lactam ◽

Delayed Reaction ◽

Allergy Testing ◽

Beta Lactam Antibiotics ◽

Patient Reported ◽

Provocation Testing ◽

Reliable Solution

Summary Background Beta-lactam antibiotics (BLA) are the treatment of choice for a large number of bacterial infections. Putative BLA allergies are often reported by patients, but rarely confirmed. Many patients do not receive BLA due to suspected allergy. There is no systematic approach to risk stratification in the case of a history of suspected BLA allergy. Methods Using the available stratification programs and taking current guidelines into account, an algorithm for risk stratification, including recommendations on the use of antibiotics in cases of compellingly indicated BLA despite suspected BLA allergy, was formulated by the authors for their maximum care university hospital. Results The hospital is in great need of recommendations on how to deal with BLA allergies. Patient-reported information in the history forms the basis for classifying the reactions into four risk categories: (1) BLA allergy excluded, (2) benign delayed reaction, (3) immediate reaction, and (4) severe cutaneous and extracutaneous drug reaction. Recommendations strictly depend on this classification and range from use of full-dose BLA or use of BLA under certain conditions (e.g., two-stage dose escalation, non-cross-reactive BLA only) to prohibiting all BLA and the use of alternative non-BLA. In case of suspected immediate or delayed allergic reactions, there is an additional recommendation regarding subsequent allergy testing during a symptom-free interval. Conclusion Triage of patients with suspected BLA is urgently required. While allergy testing, including provocation testing, represents the most reliable solution, this is not feasible in all patients due to the high prevalence of BLA allergies. The risk stratification algorithm developed for the authors’ hospital represents a tool suitable to making a contribution to rational antibiotic therapy.

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Pathways to improved antibiotic allergy and antimicrobial stewardship practice: The validation of a beta-lactam antibiotic allergy assessment tool

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2018.07.048 ◽

2019 ◽

Vol 7 (3) ◽

pp. 1063-1065.e5 ◽

Cited By ~ 14

Author(s):

Misha Devchand ◽

Karen F. Urbancic ◽

Sharmila Khumra ◽

Abby P. Douglas ◽

Olivia Smibert ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Assessment Tool ◽

Beta Lactam ◽

Beta Lactam Antibiotic ◽

Antibiotic Allergy ◽

Lactam Antibiotic

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Amoxicillin induced toxic epidermal necrolysis

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20200731 ◽

2020 ◽

Vol 9 (3) ◽

pp. 510

Author(s):

Lakshmi Narasimha G. ◽

Kalpana P.

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Toxic Epidermal Necrolysis ◽

Broad Spectrum ◽

Beta Lactam ◽

Beta Lactams ◽

Beta Lactam Antibiotic ◽

Lactam Antibiotic ◽

Life Threatening ◽

Inflammatory Drugs

Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse drug reaction associated with mucocutaneous eruptions and peeling of skin (sloughing) mostly caused by drugs like sulphonamides, beta lactams, carbamazepine and non-steroidal anti-inflammatory drugs (NSAIDs). Amoxicillin is a broad spectrum, bactericidal, Beta-lactam antibiotic used in treatment of various infections. Here by we have reported the case of amoxicillin induced severe toxic epidermal necrolysis. A Patient admitted in the hospital with the symptoms of epidermal sloughing that resulted in bare dermis as he received Amoxicillin drug for his diagnosis of fever. After clear examination TEN was confirmed and suspected with the cause due to Amoxicillin. The drug was stopped and patient was treated with other drugs for symptomatic cure. The patient was recovered from his condition and improved significantly.

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