Antibiotic allergy.

Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ
Lancet. 2019 393 (10167): 183-198

PMID: 30558872 · PMCID: PMC6563335 · DOI:10.1016/S0140-6736(18)32218-9

Antibiotics are the commonest cause of life-threatening immune-mediated drug reactions that are considered off-target, including anaphylaxis, and organ-specific and severe cutaneous adverse reactions. However, many antibiotic reactions documented as allergies were unknown or not remembered by the patient, cutaneous reactions unrelated to drug hypersensitivity, drug-infection interactions, or drug intolerances. Although such reactions pose negligible risk to patients, they currently represent a global threat to public health. Antibiotic allergy labels result in displacement of first-line therapies for antibiotic prophylaxis and treatment. A penicillin allergy label, in particular, is associated with increased use of broad-spectrum and non-β-lactam antibiotics, which results in increased adverse events and antibiotic resistance. Most patients labelled as allergic to penicillins are not allergic when appropriately stratified for risk, tested, and re-challenged. Given the public health importance of penicillin allergy, this Review provides a global update on antibiotic allergy epidemiology, classification, mechanisms, and management.

Copyright © 2019 Elsevier Ltd. All rights reserved.

MeSH Terms (12)

Anaphylaxis Anti-Bacterial Agents beta-Lactamases Cross Infection Drug Hypersensitivity Drug Resistance, Microbial Female Global Health Humans Male Penicillins Risk Factors

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