Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins
Received 28 September 2019
Accepted for publication 21 November 2019
Published 13 December 2019 Volume 2019:12 Pages 421—435
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Amrita Dosanjh
Teodorikez Wilfox Jimenez-Rodriguez,1–3 Natalia Blanca-Lopez,2,4 Maria Ruano-Zaragoza,1–3 Victor Soriano-Gomis,1,2,5 Angel Esteban-Rodriguez,6 Geronima Riera-Sendra,7 Antonio Palazon-Bru,5 Miguel Blanca,2,4 Jose Manuel Ramos-Rincon,5,8,* Javier Fernandez-Sanchez1,2,5,*
1Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain; 2ARADyAL Spanish Network, Madrid, Spain; 3PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain; 4Allergy Section, Infanta Leonor University Hospital, Madrid, Spain; 5Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain; 6Clinical Analysis Department, Alicante General University Hospital, Alicante, Spain; 7Hospital Pharmacy Department, Alicante General University Hospital, Alicante, Spain; 8Internal Medicine Department, Alicante General University Hospital, Alicante, Spain
*These authors contributed equally to this work
Correspondence: Teodorikez Wilfox Jimenez-Rodriguez
Seccion de Alergologia, Hospital General Universitario de Alicante, Calle Pintor Baeza 12, Planta 8, Alicante 03010, Spain
Purpose: Elderly people thought to have an allergy to beta-lactams (BLs) may tolerate the drugs in subsequent exposures due to initial false labeling of allergies, the spontaneous loss of sensitivity to BLs over time or age-related decline in sensitization. As a result, they may be treated with less appropriate antibiotics, causing more side effects and entailing increased costs for health systems. The aim of this investigation was to assess whether patients in the third and fourth age with previously confirmed allergies to BLs had lost sensitization and could tolerate these antibiotics.
Patients and methods: Patients allergic to BLs were divided into group A (aged 60–79 years) and B (aged ≥80 years). Clinical history, skin testing, drug challenge tests (DCT) and evaluation of resensitization were used to classify participants as showing immediate reactions, non-immediate reactions, or tolerance. We compared clinical entities, drugs involved, and final outcome by age group.
Results: Of 1362 cases evaluated, 565 underwent an allergological study. The skin was the most common organ involved. Anaphylaxis and side chain reactions were more frequent in group A (p<0.01), as were positive DCT. Classical benzylpenicillin determinants (benzylpenicilloyl and/or minor determinant mixture) were more frequent triggers in group B (p< 0.01). Resensitization after challenge occurred in very few participants.
Conclusion: The risk for allergy to BLs decreases with age and a history of anaphylaxis by BLs is a predictor of positive results in skin tests (ST). Both immunoglobin E (IgE) and T-cell–mediated responses can disappear in elderly people, who can develop tolerance to these antibiotics. These results are of clinical relevance to patients who need to be treated with antibiotics from this family.
Keywords: drug allergy, beta-lactams, cephalosporins, cross-reactivity, aging, immunosenescence, diagnosis
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