Amoxicillin hypersensitivity: patient outcomes in a seven-year retrospective study

Effects of Sex and Gender in Immediate β-Lactam Antibiotic Allergy: A Systematic Review and Meta-Analysis

BACKGROUND

β-Lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of β-lactam antibiotics.

OBJECTIVE

This systematic review and meta-analysis aimed to identify sex- and gender-based differences in the prevalence of immediate β-lactam allergy.

METHODS

We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013 and 2023. Patients with a documented β-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in β-lactam allergy with meta-analysis.

RESULTS

We included 69 primary studies assessing 53,989 participants from outpatient and inpatient cohorts. A total of 7,558 patients had a confirmed β-lactam allergy. There was no difference in the prevalence of positive β-lactam allergy test between males and females. Subgroup analysis of studies that performed oral challenges showed a higher risk of β-lactam allergy in females compared with males (relative risk = 1.40; 95% CI, 1.18-1.66; P < .001; I2 = 77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in β-lactam allergy studies.

CONCLUSIONS

Our findings suggest both sex-based and gender-based differences in the prevalence of immediate β-lactam allergy. Biological factors such as sex hormones and gender-based behaviors including increased health care use may contribute to higher rates of β-lactam allergy diagnosis in females.

Is a Prolonged Drug Provocation Test Better Than a Single-Day Drug Provocation Test? A Systematic Review and Meta-Analysis

BACKGROUND

There is currently no standardized duration of drug provocation test (DPT) for confirming/delabeling beta-lactam hypersensitivity reaction (BL-HSR).

OBJECTIVES

This meta-analysis and systematic review aimed to investigate the added diagnostic value of extended-day over single-day DPT for confirming/delabeling BL-HSR in adults and children.

METHODS

The MEDLINE, EMBASE, Web of Science, and CINAHL online databases were searched from inception to March 15, 2023, for studies that performed extended-day DPT to confirm/delabel BL-HSR. Risk difference and risk ratio were used to compare the proportions of patients with confirmed BL-HSR by single-day or extended-day DPT.

RESULTS

A total of 10,371 DPTs from 42 studies were included. Extended-day DPTs ranged from 2 to 7 days, or as long as index reactions were reported (maximum 10 days). The overall prevalence of confirmed BL-HSR was 6.96% (3.31% during the first-day DPT, and 3.65% during extended-day DPT). Approximately half of the positive reactions during extended-day DPT occurred during the second/third day. The increased detected pool prevalence of confirmed BL-HSR yielded by extended-day DPT was 0.03 (95% CI, 0.02%-0.04%; I2 = 57.69%; P < .001), and the risk ratio of positive reactions between extended-day and single-day DPT was 1.94 (95% CI, 1.62-2.33; I2 = 36.26%; P < .001). The risk difference increased per 1% increase in prevalence of BL-HSR by 0.6% (95% CI, 0.4%-0.7%; P < .001). Twenty-three severe reactions occurred during DPT, and only 2 severe reactions (0.02%) occurred during extended-day DPT. An additional 28 extended-day DPTs were needed to identify 1 mild reaction.

CONCLUSIONS

The increased prevalence of confirmed BL-HSR observed during extended-day DPT could be attributed to the first-day DPT. As a result, our findings do not conclusively support the use of extended-day DPT over single-day DPT. Further studies, incorporating a washout period, are required to comprehensively compare these 2 approaches.