International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
Breaking the barrier: Transforming the diagnosis and management of penicillin and cephalosporin allergy in China.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Wang Lanting, Chen Shengan, Lin Lin, Dai Ranran, Zhao Xiaoqing, Xu Shunming, Yu Shaoqing, Dong Wei, Zhou Xiaojian, Dong Xiaoyan, Qian Qiufang, Ni Weichun, Gu Yurong, Ye Haibo, Yuan Chao, Zhang Xiaobo, Yang Ling, Li Lei, Jin Meiling, Lee Dylan, Ma Li, Luo Xiaoqun
Аннотация
OBJECTIVES: β-lactam allergy labels are common in routine care but are variably verified. This manuscript assessed prevalence, clinical features, verification practices, and penicillin-cephalosporin cross-occurrence across multiple hospitals in China.
METHODS: We used multicenter cross-sectional questionnaires in outpatient clinics at 22 institutions (n = 6070). Adjudication relied on routine records and prior testing performed in care. "Clinically-confirmed" allergy required a chart-documented reaction and/or a previously positive skin test; indeterminate entries were coded "uncertain." Cross-occurrence required confirmation for both classes. No de novo skin testing or drug provocation was performed by the study team; severe cutaneous adverse reactions were described without re-exposure. Descriptive statistics and χ² tests were used; logistic regression adjusted for prespecified covariates (age, sex, parental allergy history).
RESULTS: Self-reported penicillin allergy was 21.9% (1331/6070); self-reported cephalosporin allergy was 4.5% (273/6070). Among respondents reporting cephalosporin allergy, 28.9% (79/273) had skin test positivity documented in routine care. Confirmed penicillin-cephalosporin cross-occurrence was 2.3% (140/6070). Testing practices varied across sites, and drug provocation was generally not implemented.
CONCLUSIONS: In this multicenter survey adjudicated from routine care, clinically-confirmed β-lactam allergy was substantially lower than self-report, and confirmed penicillin-cephalosporin cross-occurrence was uncommon (2.3%). Clear confirmation criteria and phenotype-based triage using existing documentation can support safe delabeling and more appropriate first-line β-lactam use; the accompanying standard operating procedure provides procedural detail for replication.
METHODS: We used multicenter cross-sectional questionnaires in outpatient clinics at 22 institutions (n = 6070). Adjudication relied on routine records and prior testing performed in care. "Clinically-confirmed" allergy required a chart-documented reaction and/or a previously positive skin test; indeterminate entries were coded "uncertain." Cross-occurrence required confirmation for both classes. No de novo skin testing or drug provocation was performed by the study team; severe cutaneous adverse reactions were described without re-exposure. Descriptive statistics and χ² tests were used; logistic regression adjusted for prespecified covariates (age, sex, parental allergy history).
RESULTS: Self-reported penicillin allergy was 21.9% (1331/6070); self-reported cephalosporin allergy was 4.5% (273/6070). Among respondents reporting cephalosporin allergy, 28.9% (79/273) had skin test positivity documented in routine care. Confirmed penicillin-cephalosporin cross-occurrence was 2.3% (140/6070). Testing practices varied across sites, and drug provocation was generally not implemented.
CONCLUSIONS: In this multicenter survey adjudicated from routine care, clinically-confirmed β-lactam allergy was substantially lower than self-report, and confirmed penicillin-cephalosporin cross-occurrence was uncommon (2.3%). Clear confirmation criteria and phenotype-based triage using existing documentation can support safe delabeling and more appropriate first-line β-lactam use; the accompanying standard operating procedure provides procedural detail for replication.