β-Lactam allergy delabeling is safe and saves costs in Primary Care

Abstract

ObjectiveTo determine whether the β-lactam allergy delabeling was safe and cost-saving in Primary Care (PC) patients. DesignWe have conducted a retrospective chart review of PC patients with β-lactam allergy label evaluated in our Allergy Unit between 2017 and 2022. SiteAllergy Department. Hospital Virgen del Rocio (Sevilla). ParticipantsA total of 391 patients labeled for β-lactam allergy in PC were studied. Main measurements(a) Outcome evaluation of a β-lactam allergy delabeling procedure. (b) A ratio between the total e-prescribed antibiotic cost and the number of treatment days (the experimental daily antibiotic cost or EDAC) before and after delabeling was analyzed in delabeled and truly allergic patients. ResultsThe results of skin testing were positive in 9.2% of the reported cases (36 of 391 patients). The reactions to oral provocation challenge (OPC) occurred in 2.14% of the patients who underwent negative skin testing to offending β-lactam (in 15 of 699 OPC). A total of 307 patients (78.5%) were delabeled; 70 (17.9%) had a β-lactam selective response and 14 (3.59%) reacted to both penicillin and cephalosporin. The EDAC before and after the procedure in delabeled patients was significantly lower (0.88 € vs 0.62 €, p<10−3), than that observed in truly allergic group (0.87 € vs. 0.76 €, p=not significant). ConclusionTo delabel β-lactam allergy in Primary Care patients is safe in most patients, cost-saving in antibioticotherapy, and allows identify the main clinical β-lactam allergy phenotypes that benefit from this procedure.