Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

Nicole Bradley,Dana Weinstein,Yuman Lee

doi:10.3390/allergies1020011

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 Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse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.

Highlights

Beta-lactam antibiotics are considered a first-line therapy in many bacterial infections and include agents such as penicillins, cephalosporins and carbapenems
Purpose and Methods The purpose of this review is to provide an overview of the beta-lactam allergy and highlight the role of the pharmacist in managing beta-lactam allergies
This study demonstrates the efficacy of a pharmacist-driven beta-lactam allergy assessment [28]

Summary

Introduction

Beta-lactam antibiotics are considered a first-line therapy in many bacterial infections and include agents such as penicillins, cephalosporins and carbapenems. Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as penicillin allergic do not have clinically significant IgE-mediated allergies that may hinder the use of beta-lactam therapy when indicated [2]. A true allergy, better known as an IgE-mediated or type I reaction, typically occurs immediately or within 1 h of medication administration, and can consist of hives, angioedema, wheezing, shortness of breath, and anaphylaxis [4]. Even in patients with true beta-lactam allergies, the IgE antibodies decrease over time. In patients who have previously tested positive for beta-lactam allergy, there is an expected 10% decrease per year of a subsequent positive reaction. With the avoidance of beta-lactams, 80% to 100% of patients will test negative for beta-lactam allergy 10 years after the initial positive test [3]

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Discussion

Conclusion