Full-Dose Beta-Lactam Allergy Challenges in ED

TOPLINE:

Full-dose challenges for emergency department (ED) patients with moderate, severe, and unknown beta-lactam allergies can safely reduce unnecessary antibiotic regimens, cut costs, and preserve future antibiotic efficacy.

METHODOLOGY:

This retrospective analysis evaluated the outcomes of ED patients with moderate, severe, or unknown beta-lactam allergies who were challenged with full-dose beta-lactam antibiotics.The study obtained data from electronic medical records (EMRs) of 184 patients (median age, 68 years; 65.2% women) with allergies treated using an antibiotic in the ED between January 2021 and December 2022.Overall, 90% reported having penicillin allergies, with 13%, 42.9%, and 44% experiencing severe, moderate, and unknown allergies, respectively. Additionally, 86.4% continued taking beta-lactam antibiotics at hospital admission.Demographic and clinical data were collected, including ED diagnosis, allergy severity, beta-lactam administered in the ED, drug reaction details, continuation of therapy, and documentation status.

TAKEAWAY:

Among the ED patients subjected to beta-lactam challenges, 24 had severe allergies on record, including 11 with penicillin anaphylaxis and one with cephalosporin anaphylaxis.Allergic reactions were noted in five (2.7%) patients, with two related to ceftriaxone, two to //reference.medscape.com/drug/zosyn-piperacillin-tazobactam-342485″ class=”cl_ref_drugs”>tazobactam-342485″ class=”cl_ref_drugs”>piperacillin-tazobactam, and one to nafcillin.Four patients had a rash and one had itching, with no instances of anaphylaxis; two experienced gastrointestinal intolerance owing to the beta-lactam antibiotic.Patients who experienced allergic reactions after the beta-lactam challenge had them within 72 hours of admission, with four (2.2%) having reactions in an inpatient setting and one (0.5%) in the ED.The ASP updated the EMR allergy profile of 73.4% patients, documenting the administered antibiotic, outcome, and challenge date.

IN PRACTICE:

The findings indicate that ED clinicians gain confidence by directly addressing beta-lactam allergies with full-dose antibiotics, thereby saving time and money and maintaining future antibiotic efficacy. Moreover, updating allergy details in the EMR allows for a review of challenge information to optimize antibiotic selection.

SOURCE:

This study was led by Adam M. Anderson, MD, Grand River Emergency Medical Group, Grand Rapids, Michigan, and published online in Academic Emergency Medicine.

LIMITATIONS:

Data were collected from a single institution, potentially introducing biases and limiting generalizability. The study design was retrospective, observational, and descriptive, which prevented establishing causal relationships between variables. Reliance on EMR accuracy and documentation led to instances of beta-lactam allergies being listed as “unknown,” reflecting real-life clinical practice wherein reactions may not be recalled by patients or documented.

DISCLOSURE:

The authors declared no conflicts of interest.

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