Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.

Antibiotics are one of the most frequently prescribed drugs. Unfortunately, they also are the most common cause for self-reported drug allergy, limiting the use of effective therapies. However, evidence shows that more than 90% of patients labeled as allergic to antibiotics are not allergic. Importa...

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Authors: Doña, Inmaculada, Labella, Marina, Bogas, Gádor, Sáenz de Santa María, Rocío, Salas, María, Ariza, Adriana, Torres, María José
Format: article
Publication Date:2022
Country:España
Institution:Instituto de Salud Carlos III (ISCIII)
Repository:Repisalud
Language:English
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/18731
Online Access:http://hdl.handle.net/20.500.12105/18731
Access Level:Open access
Keyword:IgE
T-cell
allergy
drug provocation test
in vitro test
skin test
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spelling Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.Doña, InmaculadaLabella, MarinaBogas, GádorSáenz de Santa María, RocíoSalas, MaríaAriza, AdrianaTorres, María JoséIgET-cellallergydrug provocation testin vitro testskin testAntibiotics are one of the most frequently prescribed drugs. Unfortunately, they also are the most common cause for self-reported drug allergy, limiting the use of effective therapies. However, evidence shows that more than 90% of patients labeled as allergic to antibiotics are not allergic. Importantly, the label of antibiotic allergy, whether real or not, constitutes a major public health problem as it directly impacts antimicrobial stewardship: it has been associated with broad-spectrum antibiotic use, often resulting in the emergence of bacterial resistance. Therefore, an accurate diagnosis is crucial for de-labeling patients who claim to be allergic but are not really allergic. This review presents allergy methods for achieving successful antibiotic allergy de-labeling. Patient clinical history is often inaccurately reported, thus not being able to de-label most patients. In vitro testing offers a complementary approach but it shows limitations. Immunoassay for quantifying specific IgE is the most used one, although it gives low sensitivity and is limited to few betalactams. Basophil activation test is not validated and not available in all centers. Therefore, true de-labeling still relies on in vivo tests including drug provocation and/or skin tests, which are not risk-exempt and require specialized healthcare professionals for results interpretation and patient management. Moreover, differences on the pattern of antibiotic consumption cause differences in the diagnostic approach among different countries. A multidisciplinary approach is recommended to reduce the risks associated with the reported penicillin allergy label.20242024-02-2720222022-08-0320222022-08-03research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articlehttp://hdl.handle.net/20.500.12105/18731reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/187312026-06-12T12:43:37Z
dc.title.none.fl_str_mv Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
title Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
spellingShingle Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
Doña, Inmaculada
IgE
T-cell
allergy
drug provocation test
in vitro test
skin test
title_short Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
title_full Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
title_fullStr Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
title_full_unstemmed Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
title_sort Antibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance.
dc.creator.none.fl_str_mv Doña, Inmaculada
Labella, Marina
Bogas, Gádor
Sáenz de Santa María, Rocío
Salas, María
Ariza, Adriana
Torres, María José
author Doña, Inmaculada
author_facet Doña, Inmaculada
Labella, Marina
Bogas, Gádor
Sáenz de Santa María, Rocío
Salas, María
Ariza, Adriana
Torres, María José
author_role author
author2 Labella, Marina
Bogas, Gádor
Sáenz de Santa María, Rocío
Salas, María
Ariza, Adriana
Torres, María José
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv IgE
T-cell
allergy
drug provocation test
in vitro test
skin test
topic IgE
T-cell
allergy
drug provocation test
in vitro test
skin test
description Antibiotics are one of the most frequently prescribed drugs. Unfortunately, they also are the most common cause for self-reported drug allergy, limiting the use of effective therapies. However, evidence shows that more than 90% of patients labeled as allergic to antibiotics are not allergic. Importantly, the label of antibiotic allergy, whether real or not, constitutes a major public health problem as it directly impacts antimicrobial stewardship: it has been associated with broad-spectrum antibiotic use, often resulting in the emergence of bacterial resistance. Therefore, an accurate diagnosis is crucial for de-labeling patients who claim to be allergic but are not really allergic. This review presents allergy methods for achieving successful antibiotic allergy de-labeling. Patient clinical history is often inaccurately reported, thus not being able to de-label most patients. In vitro testing offers a complementary approach but it shows limitations. Immunoassay for quantifying specific IgE is the most used one, although it gives low sensitivity and is limited to few betalactams. Basophil activation test is not validated and not available in all centers. Therefore, true de-labeling still relies on in vivo tests including drug provocation and/or skin tests, which are not risk-exempt and require specialized healthcare professionals for results interpretation and patient management. Moreover, differences on the pattern of antibiotic consumption cause differences in the diagnostic approach among different countries. A multidisciplinary approach is recommended to reduce the risks associated with the reported penicillin allergy label.
publishDate 2022
dc.date.none.fl_str_mv 2022
2022-08-03
2022
2022-08-03
2024
2024-02-27
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/20.500.12105/18731
url http://hdl.handle.net/20.500.12105/18731
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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