Antimicrobial anaphylaxis: the changing face of severe antimicrobial allergy

• Published in: Journal of antimicrobial chemotherapy Vol. 75; no. 1; pp. 229 - 235
• Main Authors: Hall, Victoria, Wong, Micah, Munsif, Maitri, Stevenson, Brittany R, Elliott, Katie, Lucas, Michaela, Baird, Ashleigh J, Athan, Eugene, Young, Melissa, Pickles, Robert, Cheng, Allen C, Stewardson, Andrew J, Aung, Ar K, Trubiano, Jason A
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2020
• Subjects: Adult; Adverse Drug Reaction Reporting Systems; Aged; Anaphylaxis - chemically induced; Anaphylaxis - epidemiology; Anaphylaxis - mortality; Anti-Bacterial Agents - adverse effects; Australia - epidemiology; Databases, Factual; Drug Hypersensitivity - epidemiology; Drug Hypersensitivity - mortality; Female; Follow-Up Studies; Hospitalization; Humans; Inpatients; Male; Middle Aged; Retrospective Studies; Surveys and Questionnaires; Tertiary Care Centers - statistics & numerical data; Australia
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkz422

Abstract Objectives The epidemiology, clinical characteristics and outcomes of antimicrobial-associated anaphylaxis remain ill-defined. We sought to examine antimicrobial anaphylaxis with regard to: (i) the frequency of implicated antimicrobials; (ii) attributable mortality; and (iii) referral for definitive allergy assessment. Methods This was conducted through a national retrospective multicentre cohort study at five Australian tertiary hospitals (January 2010 to December 2015). Cases of antimicrobial anaphylaxis were identified from ICD-10 coding and adverse drug reaction committee databases. Results There were 293 participants meeting the case definition of antimicrobial anaphylaxis and 310 antimicrobial anaphylaxis episodes. Of 336 implicated antimicrobials, aminopenicillins (62/336, 18.5%) and aminocephalosporins (57/336, 17%) were implicated most frequently. ICU admission occurred in 43/310 (13.9%) episodes; however, attributable mortality was low (3/310, 1%). The rate of anaphylaxis to IV antibiotics was 3.5 (95% CI=2.9–4.3) per 100 000 DDDs and the rate of hospital-acquired anaphylaxis was 1.9 (95% CI=2.1–3.3) per 100 000 occupied bed-days. We observed overall low rates of hospital discharge documentation (222/310, 71.6%) and follow-up by specialist allergy services (73/310, 23.5%), which may compromise medication safety and antimicrobial prescribing in future. Conclusions This study demonstrated that a high proportion of severe immediate hypersensitivity reactions presenting or acquired in Australian hospitals are secondary to aminopenicillins and aminocephalosporins. Overall rates of hospital-acquired anaphylaxis, predominantly secondary to cephalosporins, are low, and also associated with low inpatient mortality.