Beta-lactam Allergy
Strategies to Delabel a Beta-lactam Allergy

Strategies to Delabel a Beta-lactam Allergy

Strategies to Delabel a Beta-lactam Allergy

Nearly 30% of beta-lactam "allergies" can be clarified to be side effects (e.g. nausea), patient preferences, or identified as entered in error. An average allergy assessment interview lasts ~ 2 minutes.

Consists of giving the full dose of the implicated drug in an observed setting to rule out immediate hypersensitivity in lower risk patients. Challenges are usually done with oral drugs (e.g. amoxicillin), but can be carried out with IV antibiotics.

Consists of giving 1/10th of the intended dose, followed by the full dose in an observed setting, to rule out immediate hypersensitivity in lower risk patients. Graded challenges are usually done with oral drugs (e.g. amoxicillin), but can be carried out with IV antibiotics.

NOTE Graded challenges have not been shown to increase safety as most people who react (usually mildly), do so at the final step of the challenge.

Used to investigate immediate hypersensitivity to antibiotics in the penicillin family (e.g. penicillin, ampicillin) in patients with higher risk histories

Skin testing, if negative, is followed by a single dose of amoxicillin, and together this strategy is excellent at ruling out immediate hypersensitivity

Cephalexin is very similar to ampicillin, and skin testing has been sometimes employed, although it has not been robustly validated

Skin testing is not validated with other beta-lactams