Prevalence Of Antibiotic Allergy Research Articles

The Burden of Self-Reported Antibiotic Allergies in Health Care and How to Address It: A Systematic Review of the Evidence.

Antibiotics are the first-line treatment for bacterial infections; however, overuse and inappropriate prescribing have made antibiotics less effective with increased antimicrobial resistance. Unconfirmed reported antibiotic allergy labels create a significant barrier to optimal antimicrobial stewardship in health care, with clinical and economic implications. A systematic review was conducted to summarize the impact of patient-reported antibiotic allergy on clinical outcomes and various strategies that have been employed to effectively assess and remove these allergy labels, improving patient care. The review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A critical appraisal was conducted on all studies and a narrative synthesis was performed to identify themes. Four themes emerged: the prevalence of antibiotic allergy, impact of antibiotic allergy on antimicrobial prescribing, impact of antibiotic allergy on clinical outcomes, and delabeling strategies to improve clinical outcomes. Of the 32 studies, including 1,089,675 participants, the prevalence of reported antibiotic allergy was between 5% and 35%. Patients with a reported antibiotic allergy had poorer concordance with prescribing guidelines in 30% to 60% of cases, with a higher use of alternatives such as quinolone, tetracycline, macrolide, lincosamide, and carbapenem and lower use of beta-lactam antibiotics. Antibiotic allergy delabeling was identified as an intervention and recommendation to advance the state of the science. There is substantial evidence within the literature that antibiotic allergy labels significantly impact patient clinical outcomes and a consensus that systematic assessment of reported antibiotic allergies, commonly referred to as delabeling, improves the clinical management of patients.

Prevalence of Antibiotic Allergy at a Spinal Cord Injury Center.

Infectious diseases are the most common reason for rehospitalization in patients with spinal cord injury (SCI). Persons with SCI are at high risk for antibiotic over-use and hospital-acquired infection due to chronic bacteriuria, frequent health care exposure, implanted medical devices, and other factors. We aimed to record the percentage of subjects from the local SCI registry with an antibiotic allergy, the most common antibiotic classes responsible for the allergy, and allergic reactions. We conducted a retrospective study at the James A. Haley Veterans' Hospital in Tampa, Florida, of patients in the SCI registry between October 1, 2015, and September 30, 2017. We collected patient demographics and SCI descriptors. The outcomes included antibiotic allergy and adverse drug reactions. Of 1866 patients, 1659 met inclusion criteria; 29.8% of the subjects had a recorded allergy to antibiotics. Penicillin (13.1%), sulfa drugs (9.6%), and fluoroquinolone (4.5%) were the most common allergens. However, only 11.9% of patients with a penicillin allergy had severe reactions. Almost 30% of patients with SCI had a recorded allergy to an antibiotic. There are opportunities to examine whether approaches to confirm true reactions, such as skin testing, would help mitigate unnecessary avoidance of certain antibiotic classes due to mild adverse effects, rather than a true allergy, in the SCI population. Differentiating true allergy is the only clear way to deter unnecessary avoidance of first-line therapies for antibiotic treatment and avoid promotion of antibiotic resistance.

Increased rates of drug allergy in inflammatory bowel disease (IBD) patients compared to irritable bowel syndrome (IBS) patients and normal controls

Background and Aims: Drug allergy (rash, angioedema, anaphylactic, anaphylactoid reactions) is a frequently encountered clinical problem, and published reports suggest that it is present in up to 20% of hospitalized patients. The rate of drug allergy among patients with 1BD (Crohn's disease (CD), ulcerative colitis (UC)) has not been previously described. We hypothesized that adult patients with chronic gut inflammation would have increased rates of drug allergy compared to controls. Methods: Retrospective observational analysis was performed on all 1BD patients followed at a tertiary referral center. All intake visits were reviewed for histories of drug allergy, defined as emergence of rash, angnoedema, anaphytactic/ anaphylactoid reaction following challenge with the offending agent. Demographic information regarding patients as well as classes of agents inducing allergic reactions were recorded, as was the duration of the IBD. Controls included patients with irritable bowel syndrome as well as healthy volunteers without clinical evidence of gastrointestinal disease. Results: Records of 410 IBD patients (297 CD, 107 UC, 6 indeterminate colitis) were reviewed, as weft as 230 control patients (IBS 50, normal 180). 33.2% of IBD patients and 19% of controls demonstrated drug allergy ( p = < 0.001 Chi-square). There was no difference between the prevalence of drug allergy between CD and UC patients. The duration of disease did not impact on the prevalence of drug allergy. There were significantly more female IBD patients with drug allergy when compared to males (36% vs. 25%; p = < 0 . 0 3 ) which corresponded with an increased rate of drug allergy noted in the female control population. The classes of drugs associated with allergic reactions in IBD patients included penicillin (13.9%), sulfa (8.3%), narcotics (7.1%). The prevalence of antibiotic allergy in the IBD patients was 22% compared with 11% of controls (p = <O.001). Conclusions: The prevalence of drag allergy is significantly higher in patients with IBD compared to patients with IBS or healthy volunteers. Female IBD patients have a higher prevalence of allergic reactions compared to males, but there is no difference in the prevalence of the reactions between UC and CD Drug allergnc IBD patients are a commonly encountered phenotype which pose added clinical challenges in management.