Direct challenges are the gold standard for most antibiotic allergy evaluations

Ramsey, Allison; Rozario, Cheryl; Stern, Judith M.

doi:10.1016/j.anai.2023.03.033

Cited by 4 publications

(2 citation statements)

References 74 publications

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“…Besides all of the mentioned studies have discussed the beta-lactam allergy diagnosis tests and their importance. Furthermore, the studies evaluated in these reviews further support that many patients with previously reported beta-lactam allergies, in whom allergy interviews are conducted, can be given betalactams with no adverse events noted following administration, and overall stewardship of antibiotics is positively impacted [19][20][21][22][23][24][25].…”

Section: Article Selection and Study Demographicsmentioning

confidence: 93%

“…The purpose of this test is to confirm the diagnosis. Provocation tests involve the gradual administration of increasing doses of a medication until one or more therapeutic doses are reached, using single-blind protocols [ 20 , 23 ]. In the case of children and low-risk patients, such as those with isolated nonallergic symptoms such as itching without skin lesions or gastrointestinal symptoms, family history of penicillin allergy, or little-known reactions occurring more than 10 years ago without signs suggestive of an IgE-mediated reaction, an oral provocation test without prior skin testing is recommended.…”

Section: Reviewmentioning

confidence: 99%

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Management and Implications of Beta-Lactam Allergies

Zavaleta-Monestel,

Webster,

Rojas-Chinchilla

et al. 2024

Cureus

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Beta-lactam antibiotics are essential components in the current antimicrobial treatment strategy, playing a crucial role in ambulatory patients and hospitalized patients. Despite their prominent therapeutic index, the use of beta-lactam can lead to adverse effects, with allergic reactions being the most concerning because of their severity. Additionally, the phenomenon of cross-reactivity may occur among various beta-lactam families, with side chains significantly contributing to immunological recognition, making these structures often responsible for the cross-allergic reactivity of beta-lactams. Tools to assess beta-lactam allergy include taking a patient's medical history, performing skin tests, and conducting provocation tests. This research aims to analyze the relevant aspects related to the safe administration of beta-lactam antibiotics in hospitalized patients as well as provide knowledge on the proper management of patients with such hypersensitivity, by doing systemic research. This research was made using Google Scholar and keywords such as "Beta-lactam allergy,” "Hypersensitivity,” "Cross-reactivity,” "Desensitization,” and “Beta-lactam allergy management.” In conclusion, substituting a beta-lactam antibiotic with an alternative antibiotic may not always be the best management option for these patients, as it may lead to more adverse effects, be less effective, and prolong hospitalization time. It may also result in higher rates of antibiotic-resistant infections and increased medical costs, as these alternatives are often more expensive. However, an alternative within the beta-lactam family can be sought by conducting the appropriate analyses. Although cross-reactivity does not always occur among all beta-lactams, potential cross-reactivity should always be considered.

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