Abstract
Purpose: Drug allergies represent a significant health concern among the elderly, with beta-lactam (BL) antibiotics being one of the most implicated agents. There remains a paucity of data on the safety and efficacy of BL allergy de-labelling in this population.
We aimed to investigate the safety and efficacy of BL allergy evaluation in a cohort of geriatric patients bearing BL allergy labels.
Methods: A retrospective study, including patients aged > 65 years referred for allergy evaluation at the Allergy Unit of the Meir Hospital. Patients suspected to have BL allergy underwent a comprehensive anamnesis, skin testing, and oral challenge. Patients successfully de-labelled were subject to long-term follow-up to monitor BL use and outcomes.
Results: Over the course of 2009 to 2019, 166 elders with suspected BL allergies were evaluated. Ultimately, 145 (87.3%) patients had their BL allergies ruled out. Sixteen (9.6%) were diagnosed with IgE-mediated allergies, 4 (2.4%) with severe delayed-type hypersensitivity, and 1 (0.6%) with a benign rash. The evaluation process was safe, with no occurrences of severe reactions during oral challenges, and none of the patients required hospital admission or adrenaline treatment.
106 patients were available for long-term follow-up. Of these, 38 patients (35.8%) were subsequently treated with the previously suspected culprit drug. None reported immediate reactions or severe delayed hypersensitivity following exposure.
Conclusion: De-labelling of BL allergies is safe and effective in elders, underscoring the importance of this procedure. There is need to heighten awareness regarding allergic workups in geriatric populations bearing BL allergy labels.