Joana Guillén
Updated Saturday, January 27, 2024-02:10
Being labeled as allergic to penicillin reduces the therapeutic options one can choose if they need an effective and safe treatment to combat certain bacterial infections. That is why it is a problem that
one has a diagnosis of penicillin allergy that is incorrect
. A study by the Bellvitge University Hospital (HUB) has revealed that 75% of patients labeled as allergic to beta-lactam antibiotics or penicillins
are false positives.
In the study carried out by a clinical group headed by
Gustavo Molina
, a specialist in the Allergology Service of the Catalan center, 249 cases of people allergic to these medications have been analyzed. Of the total number of patients examined, in 186 cases (74.3% of the total) the label was removed after the allergy study.
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Specialists in Allergology, Clinical Pharmacology and Pharmacy from ICS public hospitals have also participated in the analysis, which reaffirms the results of similar investigations. The average age of the patients in the multicenter study was 55.8 years. Most
false labels come from childhood
, although antibiotic allergies usually develop between the ages of 26 and 54.
Why do these false positives occur?
There is no single explanation. "We consider it to be a multifactorial problem," says Molina. Thus, among the main causes he lists "the lack of training of specialists who evaluate reactions in the acute moment, an imprecise labeling system, the recall bias of the patients themselves, the lack of standardization in labeling as well as the trend that existed years ago to avoid beta-lactam antibiotics when an allergy was suspected instead of sending them for a specialized study. Currently, when these labels have to be placed, the patient is usually sent for an evaluation by a specialist.
Being "false allergic" to this specific medication is important due to its widespread use in routine clinical practice. Beta-lactam antibiotics "are used for the treatment of very common infectious pathologies." As an example, "they are commonly used in respiratory, urinary, skin infections, among others," says the expert.
«False allergy labels to penicillins and other beta-lactams are not a minor issue; “This is a public and personal health problem,” says Gustavo Molina. Overdiagnosis of drug allergies has several serious consequences such as the use of more harmful, more expensive and less effective therapeutic alternatives, an increase in surgical wound infections or an increase in hospitalization time.
It also promotes the growth of antibiotic resistance, in a global context of increase in multi-resistant bacteria, which represents an increasing threat to global public health.
So, what measures must be put in place?
As a specialist from the Allergology Service explains, "once a patient has a penicillin allergy label, it is necessary to
first assess the episode they suffered
and whether there is a regulated study carried out by allergy specialists that supports it."
For those individuals labeled as allergic to penicillin who have never been studied, "
performing the allergy study
on an individual basis will have to be considered."
The penicillin allergy study, describes the expert, "consists of a first visit to the allergist." In this consultation, according to the patient's medical history and taking into account his
personal medical situation,
"the risk of being truly allergic will be assessed before performing any other complementary test. An adequate prior assessment is the basis of diagnosis and safety.
No complementary tests will be carried out
"without a visit where these aspects are taken into account." Afterwards, with the data collected in the medical history, skin tests can be considered. And, depending on the case, an analytical determination "to help diagnose or rule out penicillin allergy."
With the results of these tests, the last step to evaluate is the direct test with the drug. "It consists of
controlled exposure to the penicillin suspected
of having produced the original reaction or an alternative in case previous studies indicate a clear possibility of a single penicillin."
Molina points out that
this step "is the most risky for the patient, where hypersensitivity reactions may appear
." Therefore, it must be carried out in a safe environment and be carried out by personnel trained in the identification and treatment of these reactions "as they can potentially be life-threatening."