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Beta lactam allergy

Nicholas S Sigona, Jeffrey M Steele, Christopher D Miller
OBJECTIVES: To determine the impact of a pharmacist-driven beta-lactam allergy interview on antimicrobial therapy. SETTING: Tertiary care academic medical center. PRACTICE SETTING: Clarification of beta-lactam allergy may expand treatment options for patients and potentially improve outcomes, reduce toxicity, and reduce costs. PRACTICE INNOVATION: At our institution, a pilot service using a pharmacy resident and infectious diseases clinical pharmacist was implemented to clarify beta-lactam allergy information and, where appropriate, recommend a change to the patient's antibiotic therapy...
October 8, 2016: Journal of the American Pharmacists Association: JAPhA
Anca-Mirela Chiriac, Ticha Rerkpattanapipat, Philippe-Jean Bousquet, Nicolas Molinari, Pascal Demoly
BACKGROUND: Drug provocation tests (DPT) are commonly performed as part of ß-lactam allergy work-up, in case of negative skin tests, and in the absence of contraindications. The recommendations of learned societies have created a frame for DPT performance, but protocols vary widely between centres, generating various hypothesis-driven protocols (i.e., empirical dosing, driven by both safety concerns and practical aspects). METHODS: The primary objective of this retrospective analysis was to detect eliciting dose thresholds (reactive doses) during ß-lactam DPT, using the survival analysis method, in order to suggest optimal step doses...
August 29, 2016: Allergy
Kaddy Juliana Beltrán-Sierra, Jorge Sánchez, Ricardo Cardona
BACKGROUND: Reactions to beta-lactams are frequent and it is difficult to establish the relationship between the drug and symptoms. OBJECTIVE: To describe the clinical characteristics and explore the immunological mechanisms of patients with suspected adverse reaction to beta-lactams. METHODS: Retrospective study of patients with a history of beta-lactam reaction and tests for reactions to drugs. RESULTS: Out of 125 patients, 71 were women (56...
July 2016: Revista Alergia Mexico: Organo Oficial de la Sociedad Mexicana de Alergia e Inmunología, A.C
E Moreno, E Laffond, F Muñoz-Bellido, M T Gracia, E Macías, A Moreno, I Dávila
European Network on Drug Allergy (ENDA) has proposed an algorithm for diagnosing immediate beta-lactam (BL) allergy. We evaluated its performance in real life. During 1994-2014, 1779 patients with suspected immediate reactions to BL were evaluated following ENDA's short diagnostic algorithm. Five hundred and nine patients (28.6%) were diagnosed of BL hypersensitivity. Of them, 457 (25.7%) were at first evaluation [403 by skin tests (ST), 12 by positive IgE and 42 by controlled provocation tests (CPT)]. At second evaluation (SE), 52 additional patients (10...
August 20, 2016: Allergy
Brittany Knezevic, Dustin Sprigg, Jason Seet, Michelle Trevenen, Jason Trubiano, William Smith, Yogesh Jeelall, Sandra Vale, Richard Loh, Andrew McLean-Tooke, Michaela Lucas
BACKGROUND: Patients frequently report antibiotic allergies, however only 10% of labelled patients have a true allergy. AIM: We investigated the documentation of antibiotic "allergy" labels (AALs) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. METHODS: Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys. Data was collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission, and readmissions...
August 17, 2016: Internal Medicine Journal
Paolo Marraccini, Patrizia Pignatti, Cosimo Cafforio, Marco Emilio Prini
BACKGROUND: Cutaneous tests and specific IgE are used in the diagnosis of allergy due to beta-lactans, although drug administration at therapeutic dosage is considered gold standard in drug allergy. OBJECTIVES: The diagnostic approach in symptomatic workers is more critical when they are exposed because of work, unlike reactions to drug in case of therapy. There is not a general consensus about markers in workers occupationally exposed to drugs. Indeed, basophil activation test (BAT) is a new and promising laboratory tool, particularly useful to test intermediate molecules involved in the production...
April 2016: Giornale Italiano di Medicina del Lavoro Ed Ergonomia
Fernando Baquero-Artigao, Antonio Michavila, Ángeles Suárez-Rodriguez, Anselmo Hernandez, Leticia Martínez-Campos, Cristina Calvo
The suspected allergy to beta-lactam antibiotics, especially penicillin and amoxicillin, is the most frequent reason for consultation in Child Allergy Units. In this consensus document, the clinical and diagnostic criteria of allergic reactions are described, as well as alternative antibiotic treatment for the most common infections diagnosed in paediatrics for patients with known or suspected allergy.
July 14, 2016: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Katarzyna Lewandowska, Jan Kuś
Pneumonia remains one of the main reasons of heath care system utilization. Quick diagnosis and prompt treatment initiation determine favorable outcome. Empirical antibiotic treatment allows to achieve treatment success in most patients. Treatment recommendations are based on big epidemiological trials. Nevertheless, it is sometimes necessary to know the definite etiologic factor of pneumonia. In these cases microbiological diagnostics is useful, i.e. sputum microscopy and culture, blood culture, bronchial lavage culture, bacterial antigen tests in urine, molecular tests...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Derek R MacFadden, Anthony LaDelfa, Jessica Leen, Wayne L Gold, Nick Daneman, Elizabeth Weber, Ibrahim Al-Busaidi, Dan Petrescu, Ilana Saltzman, Megan Devlin, Nisha Andany, Jerome A Leis
BACKGROUND: Reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. We prospectively evaluated the impact of these reported allergies on clinical outcomes. METHODS: We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergy on patients seen by infectious diseases consultation services at 3 academic hospitals...
October 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Matthias Zirk, Johannes Buller, Peter Goeddertz, Daniel Rothamel, Timo Dreiseidler, Joachim E Zöller, Matthias Kreppel
INTRODUCTION: Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? METHODS: We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections...
August 2016: Journal of Cranio-maxillo-facial Surgery
Michael P Makris, Theodoros N Sergentanis, Xenophon Aggelides, Stamatios Tzanninis, Efthimia Polyzou, Dimitrios Rigopoulos, Theodora Psaltopoulou
BACKGROUND: Data on self perception of drug allergy in the general population are lacking. Epidemiological studies focus either on specific populations or document adverse drug reactions in general. Our objective was to document self-reported drug allergy in Greece, through a simple, informative internet-based questionnaire. METHODS: A questionnaire on drug allergy was accessible online for a 3-month period. Participants voluntarily answered 28 questions referring to: suspected drug, clinical manifestations, concomitant factors, received treatment, reaction's re-occurrence...
June 11, 2016: Allergology International: Official Journal of the Japanese Society of Allergology
D Rodriguez-Pardo, C Pigrau, D Campany, V Diaz-Brito, L Morata, I C de Diego, L Sorlí, S Iftimie, R Pérez-Vidal, G García-Pardo, T Larrainzar-Coghen, B Almirante
Switching from intravenous to oral antibiotic therapy may improve inpatient management and reduce hospital stays and the complications of intravenous treatment. We aimed to assess the effectiveness of intravenous-to-oral antibiotic switch therapy and an early discharge algorithm in hospitalized patients with gram-positive infection. We performed a prospective cohort study with a retrospective comparison cohort, recruited from eight tertiary, acute-care Spanish referral hospitals. All patients included had culture-confirmed methicillin-resistant gram-positive infection, or methicillin-susceptible gram-positive infection and beta-lactam allergy and had received intravenous treatment with glycopeptides, lipopeptides, or linezolid...
August 2016: European Journal of Clinical Microbiology & Infectious Diseases
Marina Atanaskovic-Markovic, Francesco Gaeta, Biljana Medjo, Marija Gavrovic-Jankulovic, Tanja Cirkovic Velickovic, Vladimir Tmusic, Antonino Romano
BACKGROUND: Non-immediate reactions to beta-lactam antibiotics (BL) occur more than one hour after drug administration, and the most common manifestations are maculopapular exanthemas and delayed-appearing urticaria and/or angioedema. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions (DHR), if a drug is taken at the same time. The most of children are labeled as 'drug allergic' after considering only the clinical history. OBJECTIVE: To diagnose/detect a hypersensitivity or an infection which mimic DHR in children with non-immediate reactions to BL METHODS: A prospective survey was conducted in a group of 1026 children with histories of non-immediate reactions to BL by performing patch tests, skin tests, and in case of negative results, drug provocation tests (DPTs)...
August 2016: Pediatric Allergy and Immunology
Nirav S Shah, Jessica P Ridgway, Natasha Pettit, John Fahrenbach, Ari Robicsek
BACKGROUND: Allergy documentation is frequently inconsistent and incomplete. The impact of this variability on subsequent treatment is not well described. OBJECTIVE: To determine how allergy documentation affects subsequent antibiotic choice. DESIGN: Retrospective, cohort study. PARTICIPANTS: 232,616 adult patients seen by 199 primary care providers (PCPs) between January 1, 2009 and January 1, 2014 at an academic medical system...
2016: PloS One
Ru-Xin Melanie Foong, Kirsty Logan, Michael Richard Perkin, George du Toit
BACKGROUND: Beta-lactam allergy is commonly suspected in childhood with health implications for the individual and wider public. Diagnostic modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) tests, intradermal tests (IDT) and drug provocation challenges (DPC). The aim of this research was to establish whether variation exists around the world in the investigation and management of beta-lactam allergy. METHODS: Anonymized electronic questionnaire surveys were distributed over 3 months through International Allergy Societies for completion by clinicians who investigate drug allergy in children...
August 2016: Pediatric Allergy and Immunology
Antonino Romano, Francesco Gaeta, Maria Francisca Arribas Poves, Rocco Luigi Valluzzi
Penicillins and cephalosporins are the major classes of beta-lactam (BL) antibiotics in use today and one of the most frequent causes of hypersensitivity reactions to drugs. Monobactams, carbapenems, oxacephems, and beta-lactamase inhibitors constitute the four minor classes of BLs. This review takes into account mainly the prospective studies which evaluated cross-reactivity among BLs in subjects with a well-demonstrated hypersensitivity to a certain class of BLs by performing allergy tests with alternative BLs and, in case of negative results, administering them...
March 2016: Current Allergy and Asthma Reports
Seejil Dan, Ansal Shah, Julie Ann Justo, P Brandon Bookstaver, Joseph Kohn, Helmut Albrecht, Majdi N Al-Hasan
Increasing rates of fluoroquinolone resistance (FQ-R) have limited empirical treatment options for Gram-negative infections, particularly in patients with severe beta-lactam allergy. This case-control study aims to develop a clinical risk score to predict the probability of FQ-R in Gram-negative bloodstream isolates. Adult patients with Gram-negative bloodstream infections (BSI) hospitalized at Palmetto Health System in Columbia, South Carolina, from 2010 to 2013 were identified. Multivariate logistic regression was used to identify independent risk factors for FQ-R...
April 2016: Antimicrobial Agents and Chemotherapy
Sara M Swearingen, Cyle White, Sara Weidert, Melisande Hinds, John P Narro, Anthony J Guarascio
BACKGROUND: Local antimicrobial susceptibility patterns should be considered for antimicrobial therapy decisions. Antibiogram data can guide beta-lactam antibiotic use in the presence of a penicillin allergy, particularly when allergic cross-reactivity among antibiotic agents is unlikely. OBJECTIVE: To evaluate the effect of a multidimensional antimicrobial stewardship intervention to improve antibiogram-driven antibiotic selection for patients with a reported penicillin allergy receiving aztreonam...
April 2016: International Journal of Clinical Pharmacy
Jason A Trubiano, Kelly A Cairns, Jacqui A Evans, Amally Ding, Tuan Nguyen, Michael J Dooley, Allen C Cheng
BACKGROUND: The prevalence and impact of antimicrobial "allergy" labels and Adverse Drug Reactions (ADRs) on antibiotic usage and antimicrobial stewardship initiatives is ill defined. We sought to examine the rate of antimicrobial "allergy labels" at our tertiary referral centre and impacts on antimicrobial usage and appropriateness. METHODS: Two inpatient antimicrobial prevalence surveys were conducted over a 1-week period in November 2013 and 2014 as part of the prospective National Antimicrobial Prescribing Survey (NAPS)...
2015: BMC Infectious Diseases
Emine Vezir, Emine Dibek Misirlioglu, Ersoy Civelek, Murat Capanoglu, Hakan Guvenir, Tayfur Ginis, Muge Toyran, Can N Kocabas
BACKGROUND: Skin testing has a limited role in the diagnosis of non-immediate beta-lactam hypersensitivity in children. The aim of this study was to report the results of oral provocation tests performed without skin tests in children with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics. METHODS: Oral provocation tests with suspected antibiotics were performed to patients with non-immediate mild cutaneous reactions without systemic symptoms caused by beta-lactam antibiotics...
February 2016: Pediatric Allergy and Immunology
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