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Meehl S, Salathe C, Cooley C, Jordan-Villegas A, Laham FR, Madala A, Cowart M. Beta-Lactam Allergy De-labeling in a Pediatric Hospital. J Pediatr Pharmacol Ther 2024; 29:169-174. [PMID: 38596425 PMCID: PMC11001211 DOI: 10.5863/1551-6776-29.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/15/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To assess the ability to de-label pediatric patients of their beta-lactam allergy by using a newly implemented institutional protocol and to identify potential barriers to the de-labeling process. METHODS All patients with reported allergies to prespecified beta-lactam antibiotics were eligible for a -beta-lactam allergy interview. Following the interview, patients were grouped into 4 risk categories-no risk, low risk, moderate risk, and high risk-and assessed for intervention eligibility. Potential interventions included de-labeling based on the interview alone or proceeding to an oral amoxicillin challenge with or without penicillin allergy skin testing. RESULTS Of the 62 patients eligible for beta-lactam allergy interviews, 40% (n = 25) were de-labeled. Among de-labeled patients, 60% (n = 15) were de-labeled on the basis of the interview alone. Additionally, no failures were documented in patients who underwent an oral amoxicillin challenge or penicillin skin testing. Barriers to performing oral amoxicillin challenges or penicillin skin testing included concomitant systemic steroid or antihistamine use, refusal of intervention, and insufficient resources to perform penicillin skin testing. CONCLUSIONS There was a high frequency of patients de-labeled of their beta-lactam allergies in this study. Increased education to patients, parents, and providers on the de-labeling process, as well as increased personnel available to coordinate and perform de-labeling interventions, may result in more beta-lactam allergy de-labeling.
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Affiliation(s)
- Shawn Meehl
- Department of Pharmacy (SM, CS, MC, CC), Arnold Palmer Hospital for Children, Orlando, FL
| | - Christina Salathe
- Department of Pharmacy (SM, CS, MC, CC), Arnold Palmer Hospital for Children, Orlando, FL
| | - Chelsea Cooley
- Department of Pharmacy (SM, CS, MC, CC), Arnold Palmer Hospital for Children, Orlando, FL
| | - Alejandro Jordan-Villegas
- Department of Infectious Diseases and Antimicrobial Stewardship (FRL, AJ-V), Arnold Palmer Hospital for Children, Orlando, FL
| | - Federico R. Laham
- Department of Infectious Diseases and Antimicrobial Stewardship (FRL, AJ-V), Arnold Palmer Hospital for Children, Orlando, FL
| | - Akshita Madala
- Department of Pediatric Residency Program (AM), Arnold Palmer Hospital for Children, Orlando, FL
| | - Mallory Cowart
- Department of Pharmacy (SM, CS, MC, CC), Arnold Palmer Hospital for Children, Orlando, FL
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Rodríguez-Alarcón A, Barceló-Vidal J, Echeverría-Esnal D, Sorli L, Güerri-Fernández R, Ramis Fernández SM, Benitez-Cano A, Sendra E, López Montesinos I, Membrilla-Fernández E, Ferrández O, Adalia R, Horcajada JP, Escolano F, Gómez-Zorrilla S, Grau S. Antibiotic desensitization as a potential tool in antimicrobial stewardship programs: retrospective data analysis and systematic literature review. Expert Rev Anti Infect Ther 2022; 20:1491-1500. [PMID: 36069242 DOI: 10.1080/14787210.2022.2122443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Antibiotic allergy labels (AAL) are related to worse therapeutic results. Strategies to improve the management of these patients, such as the implementation of antibiotic desensitization, are essential for Antimicrobial Stewardship Programs (ASP). The aim of our study is to evaluate the efficacy and safety of antibiotic desensitization procedures for the management of patients with AAL. METHODS A retrospective study from 2015 to 2022 was performed to describe all antibiotic desensitization conducted in our institution, within the framework of ASP. A systematic literature review using electronic databases, such as PubMed, was also done to identify studies describing antibiotic desensitization between 2000 and 2022. RESULTS Sixteen antibiotic desensitization protocols were carried out in our institution. In fourteen cases, the desensitization was successfully completed, and the antibiotic could be used to treat the infection. In the systematic review, twenty-two studies were included, with a total of 202 desensitization episodes . In 97% of them, the desensitization was completed successfully. No desensitization-related mortality was observed neither in our cohort nor in literature review. CONCLUSIONS Antibiotic desensitization strategies should be considered a safe and effective tool that can be included in ASP for patients with a high risk of or confirmed allergy to penicillin.
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Affiliation(s)
- Alicia Rodríguez-Alarcón
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jaime Barceló-Vidal
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Daniel Echeverría-Esnal
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Luisa Sorli
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Güerri-Fernández
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sofía Martina Ramis Fernández
- Pediatrics Service, Hospital del Mar de Barcelona. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Adela Benitez-Cano
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Estela Membrilla-Fernández
- Surgery Service, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Fabra, Barcelona, Spain
| | - Olivia Ferrández
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ramón Adalia
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Escolano
- Department of Anesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital Del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigacion Biomedica en Red Enfermedades Infecciosas, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management. ALLERGIES 2021. [DOI: 10.3390/allergies1020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as beta-lactam allergic do not have clinically significant allergies that may hinder the use beta-lactam therapy when indicated. Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse effects, and use of broader spectrum antibiotics than indicated, which may contribute to antimicrobial resistance. The purpose of this review is to provide an overview of beta-lactam allergy and highlight the role of pharmacists in managing beta-lactam allergies. Studies have shown that pharmacists can play a vital role in allergy assessment, penicillin skin testing, beta-lactam desensitization, evaluation of beta-lactam cross-reactivity and recommending appropriate antibiotic therapy in patients with beta-lactam allergies.
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