Does this ED patient really have a beta-lactam allergy?

  • Maguire M & al.
  • World Allergy Organ J
  • 1 ene. 2020

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Testing for β-lactam allergies can be feasible in the emergency department (ED).
  • The vast majority of patients in this single-center study did not have a hypersensitivity reaction (HSR). 

Why this matters

  • Most reported β-lactam allergies do not represent clinically important reactions.
  • Unnecessarily avoiding β-lactams can compromise care.
    • A history of penicillin allergy can result in longer time to first antibiotic dose.
  • This study examines use in ED of antibiotic allergy testing pathways designed for and already in use with inpatients.
    • ED is well-equipped to respond to allergic reactions.

Key results

  • Test doses administered for:
    • Cephalosporins (n=262; 85%). 
    • Penicillins (n=37; 12%). 
    • Carbapenems (n=11; 4%).
  • HSRs occurred in 3.2% of patients (n=10).
    • Reactions included anaphylaxis, throat closing, hypotension, and rash.
  • Adherence was documented in 71% (n=219).
    • Two-thirds of nonadherent cases comprised administration of test doses when a mild reaction permitted full dosing, per protocol.

Study design

  • Single-center implementation study of penicillin and cephalosporin hypersensitivity test pathways in ED (n=310).
  • ED provider ordered standardized 2-step test doses of antibiotic they wished to use. 
  • Outcomes: pathway compliance, HSRs, allergy documentation.
  • Funding: Partners Quality, Safety, and Value; Partners Clinical Process Improvement Leadership Program.

Limitations

  • Small retrospective study.