Antibiotic allergy

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 pa...

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Bibliographic Details
Published in:The Lancet (British edition) 2019-01, Vol.393 (10167), p.183-198
Main Authors: Blumenthal, Kimberly G, Peter, Jonny G, Trubiano, Jason A, Phillips, Elizabeth J
Format: Article
Language:English
Subjects:
Allergies
Amides
Anaphylaxis
Anaphylaxis - etiology
Anti-Bacterial Agents - adverse effects
Antibiotic resistance
Antibiotics
beta-Lactamases - adverse effects
Classification
Cross Infection - epidemiology
Cross Infection - therapy
Drug Hypersensitivity - classification
Drug Hypersensitivity - diagnosis
Drug Hypersensitivity - epidemiology
Drug Hypersensitivity - therapy
Drug Resistance, Microbial
Drugs
Epidemiology
Female
Fever
Global Health
Humans
Hypersensitivity
Immunology
Infections
Liver
Lymphocytes
Male
Patients
Penicillin
Penicillins - adverse effects
Prophylaxis
Public health
Risk Factors
β-Lactam antibiotics
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Summary: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.
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(18)32218-9