Administration of ?-lactam antibiotics to patients with reported penicillin allergy in the emergency department

Background: beta-lactam antibiotics are amongst the most commonly prescribed medications in the Emergency Department (ED) due to their role in empiric sepsis therapy; however, inferior therapeutic options are often utilized due to a reported allergy; penicillin (PCN) being most frequent. In the United States, 10% of the population endorses an allergic reaction to PCN while <1% experience IgE-mediated reactions. This study aimed to evaluate the frequency and outcome of patients in the ED whose PCN allergies were challenged with beta-lactam antibiotics. Methods: We conducted a retrospective chart review of patients in the ED at an academic medical center aged >= 18, and who received a beta-lactam despite a reported PCN allergy between January 2015 and December 2019. Patients who did not receive a beta-lactam or did not report a PCN allergy prior to administration were excluded. The primary outcome was the frequency of IgE-mediated reactions in response to beta-lactam administration. A secondary outcome assessed the frequency of continuation of beta-lactams upon admission from the ED. Results: 819 patients were included (66% female) with prior reported PCN reactions: hives (22.5%), rash (15.4%), swelling (6.2%), anaphylaxis (3.5%), other (12.1%), or undocumented on medical electronic record (40.3%). No patients experienced an IgE-mediated reaction to the beta-lactam administered in the ED. Previously reported allergies had no effect on the continuation of beta-lactams when admitted or discharged (OR: 1, 95% CI: 0.7-1.44). Patients who had a history of an IgE-mediated penicillin allergy were frequently continued (77%) on a beta-lactam after leaving the ED via admission or discharge. Conclusion: beta-lactam administration in patients with previously reported PCN allergies did not result in any IgE-mediated reactions nor in an increase in adverse reactions. Our data contributes to the body of evidence that supports the administration of beta-lactams to patients with documented PCN allergies. (c) 2023 Published by Elsevier Inc.

Automated summary

This study retrospectively analyzed the cases of patients with reported penicillin allergy who received beta-lactam antibiotics in the emergency department between 2015 and 2019. The results showed that there were no IgE-mediated allergic reactions after the administration of beta-lactam antibiotics in the emergency department, and the previously reported penicillin allergy did not affect the continuation of beta-lactam antibiotics after discharge.