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Beta-lactam Allergy Review: Implications for Antimicrobial Stewardship Programs

  • Antimicrobial Stewardship (M Stevens, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of review

Beta-lactam allergies, and specifically penicillin allergies, result in receipt of therapy that is not considered first line in many instances. Being labeled as allergic many times comes via subjective history from the patient. Carrying this label can cause a patient to receive broad-spectrum therapy with increased side effects and resistance. Antimicrobial stewardship programs can play a role in allergy evaluation and intervention based on resources. This review provides an update on beta-lactam allergies and emphasizes incorporation of evaluating these patients as a core tenant of antimicrobial stewardship.

Recent findings

Many patients with a listed beta-lactam allergy are not truly allergic and can have the allergy removed with proper evaluation. Patients who have low-risk histories that are unlikely to be IgE mediated can safely be re-challenged. High-risk patients or those with an unknown history can be desensitized or skin tested (if allergic to penicillin). All strategies should result in proper labeling or de-labeling in the electronic health record. Antimicrobial stewardship programs are recommended to be involved in allergy assessments to create testing and treatment strategies.

Summary

Deciding whether an allergic patient is a candidate for re-challenge or graded-challenge, penicillin skin testing, or desensitization is paramount to antimicrobial stewardship programs in conjunction with an allergist, if available.

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Author information

Authors and Affiliations

  1. St. Joseph’s/Candler Health System, Inc., 5353 Reynolds Street, Savannah, GA, 31405, USA

    Bruce M. Jones Pharm.D., BCPS

  2. OhioHealth Mansfield and Shelby Hospitals Campuses, Mansfield, OH, USA

    Caroline Jozefczyk Pharm.D.

  3. Seton Healthcare Family, Austin, TX, USA

    Christina Maguire Pharm.D.

  4. Infectious Diseases McLeod Health, Florence, SC, USA

    Stephanie Milliken Pharm.D., BCIDP, AAHIVP

  5. Infectious Diseases Lee Health, Fort Myers, FL, USA

    Emily E. Weisz Pharm.D., BCPS

  6. St. Joseph’s/Candler Health System, Inc., University of Georgia College of Pharmacy, Savannah, GA, USA

    Christopher M. Bland Pharm.D., FCCP, FIDSA, BCPS

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  1. Bruce M. Jones Pharm.D., BCPS
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  2. Caroline Jozefczyk Pharm.D.
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  3. Christina Maguire Pharm.D.
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  4. Stephanie Milliken Pharm.D., BCIDP, AAHIVP
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Correspondence to Bruce M. Jones Pharm.D., BCPS.

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Conflict of interest

B.J. and C.B. have received research funding from ALK-Abello and have both served as consultants for ALK-Abello. C.M. declares she has no conflict of interest S.M. declares that she has no conflict of interest. E.W. declares that she has no conflict of interest. C.J. declares that she has no conflict of interest.

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Jones, B.M., Jozefczyk, C., Maguire, C. et al. Beta-lactam Allergy Review: Implications for Antimicrobial Stewardship Programs. Curr Treat Options Infect Dis 11, 103–114 (2019). https://doi.org/10.1007/s40506-019-00186-5

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