Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing

AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group

Research output: Contribution to journalReview articlepeer-review

45 Scopus citations


All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lactams and remove these inaccurate allergy reports. Harmonizing testing protocols, when possible, may lead to more widespread use of narrow-spectrum beta-lactams, when clinically indicated, and improve patient safety worldwide. Further research is needed to better understand the regional differences in reporting beta-lactam allergy as this relates to regional differences in beta-lactam use and overuse, the frequency of clinically significant immunologically mediated beta-lactam hypersensitivity, and the optimal testing strategies to confirm current tolerance, based on presenting clinical symptoms.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2019


  • Allergy
  • Beta-lactam
  • Cephalosporin
  • Challenge
  • Drug provocation test
  • Hypersensitivity
  • IgE
  • Penicillin
  • Severe cutaneous adverse reaction
  • Skin test
  • T cell

ASJC Scopus subject areas

  • Immunology and Allergy


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