Allergy to Betalactams Antibiotics at the End-of-Life Care

Abstract

Beta-lactam antibiotics are one of the most common cause of drug allergies. There are not enough evidence-based investigations at the end-of-life care. The aims of this study was mainly to determine the actual prevalence of allergy to beta-lactams in patients elderly than 80 years admitted to the Internal Medicine Service of Alicante University Hospital (AUH), Spain; and secondary to assess the cost of replacing betalactams with second-line antibiotics. METHODS: This cross-sectional study was initiated in December 2014. Skin tests with BPO, MDM from Diater Spain, penicillin G, amoxicillin, cefuroxime and the responsible drug were performed. IgE to penicillin, amoxicillin and cefaclor were carried out by CAP Thermofisher. Controlled challenge was done after negative allergic study. The protocol was approved by the Ethics Committee. RESULTS: Until now 1723 patients were admitted, 106 of them (6.2%) reported allergy to betalactams and 70 of this (66%) agreed to participate in the study. Skin tests were performed on 63 of 70 patients (94%), and serum specific IgE to 53 of 70 patients (75.6%). But, only 2 (2.9%) were positive, 1 to amoxicillin and 1 to penicillin. 34 patients (48.6%) were under controlled challenge with no adverse reactions, and they followed penicillin treatment. The cost of patients treated versus non treated with betalactams during their stay at hospital was calculated. CONCLUSIONS: Calculated prevalence of allergy to betalactam antibiotics was 2.86%. Beta-lactam allergy was ruled out in 48.6% of the patients reporting penicillin allergy. Treatment with beta-lactams is less expensive to treat uncomplicated infections.

<p>Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins</p>

“…Our aim was to confirm if patients’ past BL allergy still remained and to establish the relationship between decreased immune response and the presence of allergy. Based on current knowledge regarding immunity in the very elderly,20 our hypothesis was that age-related decline of both cellular and humoral immune response36–38 could result in tolerance to BLs in patients who had previous allergies with IgE- or T cell-mediated reactions. For this purpose, we compared two groups of patients, the first aged 60 to 79 years, and the second aged 80 or older.…”

“…We found that a significant number of patients, mainly in the older group, had been treated with BLs—despite having a history of allergy to BL and in some cases with active alarm systems in medical records—without reporting any adverse reaction. These observations20 and the fact that 29 patients had been diagnosed by an Allergist, led us to undertake this study.…”

“…Preliminary evidence from our group indicates that older people have a lower prevalence of BL allergy than the general population 20. Based on these observations, our aim was to estimate the prevalence before and after an allergological work-up in elderly patients who were referred to our centers for a study on BL allergy after having been previously diagnosed as allergic in different medical services including Geriatrics, Internal Medicine, and Family Medicine.…”