Safety and value of pretransplant antibiotic allergy delabeling in a quaternary transplant center

Abstract

Background: Self-reported antibiotic allergies, also known as antibiotic allergy labels, are common and may lead to worse patient outcomes. Within immunocompromized patients, antibiotic allergy labels can lead to inappropriate use of antimicrobials and may limit options for prophylactic and therapeutic options in the posttransplant period.While antibiotic allergy delabeling is considered an important aspect of antibiotic stewardship protocols, evidence and awareness of its application in transplant recipients is limited. Methods:We describe our experience with an antibiotic allergy delabeling intervention in the pretransplant evaluation period and its impact on posttransplant antimicrobial utilization. This was a retrospective analysis of patients with an antibiotic allergy label who underwent evaluation for solid organ or stem cell transplantation between 2015 and 2020. Patients included in this analysis were those who completed pretransplant antibiotic allergy delabeling through our Drug Allergy Clinic and were retained in care for 6 months after transplant.Results: Twenty-six of 27 patients underwent pretransplant antibiotic allergy delabeling and safely received the delabeled antibiotic posttransplant. There were no reported side effects to the delabeled antibiotic within 6 months posttransplant. Specific examination of sulfonamide (sulfa)-antibiotic delabeling showed cost savings of $254 to $2910 per patient in the posttransplant period compared to the use of alternative antibiotics for prophylaxis protocol. Conclusion:Antibiotic allergy delabeling prior to transplant is safe, is of high value, and should be considered in the pretransplant evaluation period. More resources are needed for the development of delabeling guidelines and support for broad implementation of pretransplant antibiotic allergy delabeling programs.

Bring it on again: antimicrobial stewardship in transplant infectious diseases: updates and new challenges

“…Gorsline et al found that sulfa antibiotic delabeling of 11 SOT recipients resulted in an estimated $254–$2910 saved per patient. 50 …”

“…Gorsline et al found that sulfa antibiotic delabeling of 11 SOT recipients resulted in an estimated $254-$2910 saved per patient. 50 Clinicians may administer validated questionnaires such as PEN-FAST to identify patients who can be delabeled outright and those who require allergy testing or desensitization. 43,44 Desensitization should be conducted pre-transplant, given the often fluctuating clinical status post-transplantation.…”

Antimicrobials in patients with hematologic malignancies and recipients of hematopoietic cell transplantation and other cellular therapies

“…Pretransplant antibiotic allergy evaluation has been successfully implemented at some centers leading to de-labeling of most reported allergies and increased use of preferred agents. [24][25][26] Therefore, detailed history taking and nuanced reporting on allergy is essential. Furthermore, the allergy guidelines have clarified the risk of cross-reactivity among beta-lactams is lower than previously suggested.…”

“…Beta‐lactam allergies are associated with increased use of second‐line, nonstandard antimicrobial agents. Pretransplant antibiotic allergy evaluation has been successfully implemented at some centers leading to de‐labeling of most reported allergies and increased use of preferred agents 24–26 . Therefore, detailed history taking and nuanced reporting on allergy is essential.…”