Accuracy of penicillin and cephalosporin allergy labeling in a tertiary care center in Lebanon: a retrospective chart review

• DOI: 10.1016/j.jgar.2024.10.090
• Publication Date: 2024-12-26T04:11:42Z
• Authors: Nisrine Haddad; Amar Zaidan; Mohamad Watfa; Georgeio Sader; Remie El Helou; Nesrine Rizk
• Keywords: Middle East and North Africa (MENA) region; Penicillin allergy; Allergy labeling; Antibiotic management; Antimicrobial stewardship; Microbiology; QR1-502

AIM: This study aims to evaluate the accuracy of reported penicillin allergies at a tertiary referral center in Lebanon. BACKGROUND: Penicillin allergy is among the most commonly reported drug allergies worldwide. According to the CDC, around 10% of the U.S. population claim a penicillin allergy, but less than 1% have a confirmed IgE-mediated reaction. Often unverified, these self-reported allergies can lead to unnecessary broad-spectrum antibiotic use, prolonged hospital stays, and limited treatment options, ultimately compromising patient care. METHODS: We conducted a 5-year retrospective chart review of patients labeled with penicillin and/or cephalosporin allergies in electronic medical records. We assessed the accuracy of these labels by documenting any subsequent antibiotic exposures and reactions. RESULTS: Out of 1200 eligible patients, 529 charts were reviewed. The mean age was 63 years, with 69.6% females. Most patients (71%) were outpatients, with 96% reporting a penicillin allergy. Symptoms included rash (55%), swelling (20%), and anaphylaxis (13%). Only 1.3% of cases had confirmed allergies, while 14.8% required de-labeling, and 83.7% had inconclusive results. Severe reactions significantly reduced the likelihood of future antibiotic prescriptions (p=0.036). CONCLUSION: This study, the first of its kind in the Middle East and North Africa, highlights the low rate of confirmed penicillin allergies and the high frequency of inconclusive results. It underscores the need for accurate allergy labeling, recommending comprehensive assessments, including questionnaires and IgE testing, to improve antibiotic management and patient outcomes.