Beta-lactam Allergy

About this Tool

This algorithm can be used to:

  • Select a non-cross reacting beta-lactam AND/OR

  • Delabel (remove) the allergy using strategies like Direct Challenge or Skin Testing, if indicated

When delabeling strategies are being considered (e.g. Skin Testing or Direct Challenge), the pathway will provide practical guidance on these procedures

Use of Tool

  • serious allergy to more than 2 unrelated beta-lactams

  • patient refuses a beta-lactam despite education

  • questions cannot be answered with a reasonable degree of certainty

Pregnancy does not alter the likelihood of reacting or cross-reacting to a beta-lactam

Most experts agree that pregnant patients should NOT be treated differently, especially when:

  • selecting non-cross reacting alternatives

  • in cases of intolerance

  • in cases of delayed reactions

Most clinicians use caution in Type I immediate reactions when considering the offending agent, and are generally uncomfortable challenging pregnant patients without testing

Ideally, if skin testing is indicated, this should be performed by an allergist or someone with experience

Evidence regarding Direct Challenges in pregnancy is lacking; most agree that it can be done in patients with low risk histories

Use the algorithm for any applicable specific guidance in pregnant patients

While most experts agree that the information in this pathway can be applied to kids, particularly the cross-reactivity assessment, detailed guidance pertaining to allergy management and delabeling in pediatrics will be updated upon completion of the allergy initiative led by Dr. Jennifer Balfour

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