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

Abstract

PurposeElderly people thought to have an allergy to beta-lactams (BLs) may tolerate the drugs in subsequent exposures due to initial false labeling of allergies, the spontaneous loss of sensitivity to BLs over time or age-related decline in sensitization. As a result, they may be treated with less appropriate antibiotics, causing more side effects and entailing increased costs for health systems. The aim of this investigation was to assess whether patients in the third and fourth age with previously confirmed allergies to BLs had lost sensitization and could tolerate these antibiotics.Patients and methodsPatients allergic to BLs were divided into group A (aged 60–79 years) and B (aged ≥80 years). Clinical history, skin testing, drug challenge tests (DCT) and evaluation of resensitization were used to classify participants as showing immediate reactions, non-immediate reactions, or tolerance. We compared clinical entities, drugs involved, and final outcome by age group.ResultsOf 1362 cases evaluated, 565 underwent an allergological study. The skin was the most common organ involved. Anaphylaxis and side chain reactions were more frequent in group A (p<0.01), as were positive DCT. Classical benzylpenicillin determinants (benzylpenicilloyl and/or minor determinant mixture) were more frequent triggers in group B (p< 0.01). Resensitization after challenge occurred in very few participants.ConclusionThe risk for allergy to BLs decreases with age and a history of anaphylaxis by BLs is a predictor of positive results in skin tests (ST). Both immunoglobin E (IgE) and T-cell–mediated responses can disappear in elderly people, who can develop tolerance to these antibiotics. These results are of clinical relevance to patients who need to be treated with antibiotics from this family.

Immunoallergic disorders in the elderly

“…The most often suspected and excluded drugs were beta-lactam and macrolide antibiotics, local anaesthetics, and iodinated contrast agents. Exclusion of drug allergy has a huge importance as it allows these elderly patients to receive the most effective and less toxic drug and, in the case of antibiotic agents, contributes to improve the resistance profile of many bacterial microorganisms (27). Food allergy had a relatively low frequency in this aged population, mimicking other published studies (6).…”

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

“…We included 30 primary studies that assessed the frequency of cefazolin allergy in series of patients with self-reported or confirmed penicillin allergy (Table 1). The included primary studies had been published between 1976 and 2020, assessing a total of 6001 participants. In 9 studies, penicillin allergy was confirmed by diagnostic testing (skin, in vitro, and/or drug challenges).…”

Safe De-Labeling of Patients at Low Risk of Penicillin Allergy in Denmark

“…It is important to recognize that no reactions were characterized as severe reactions in our two cohorts totaling 1,961 de-labeled patients, and benign MPEs were the most common presentation after DPT. Some countries report aminopenicillins to be a common cause of anaphylaxis [66,67], while other countries mainly see benign reactions, like MPEs [4,61,64]. Geographical differences in exposure or genetics may play a role in the allergic reaction patterns to amoxicillin.…”