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Allergies to Non-Beta-Lactam Antibiotics: How Common and How Concerning? :

December 5, 2019

We have published studies on penicillin allergies, including studies that demonstrate that a substantial number of children labeled as being penicillin allergic are not.

We have published studies on penicillin allergies, including studies that demonstrate that a substantial number of children labeled as being penicillin allergic are not. What about non-beta-lactam antibiotics (NBLA)? Although they are used commonly, information on allergies to this class of antibiotics is limited. This week, we are early releasing a study by Grinlington et al (10.1542/peds.2019-2256) evaluating children hospitalized between 2011 and 2018 who had skin testing, a challenge test to NBLA. The authors report on 141 children studied, 18.1% had an allergy.  Trimethoprim-sulfamethoxazole was the most common allergy (15/46 or 32.6%) followed by macrolide antibiotics. Of the 4 children who had had reported anaphylactic-like reactions, none of these patients demonstrated a similar reaction on rechallenge.

Given that approximately 80% of children with NBLA allergy were found not to have a true allergy characterized by a positive challenge test, it seems prudent to confirm an NBLA positive challenge test sooner than later so as not to avoid use of NBLA as first line treatment when indicated. We welcome your thoughts on this topic and your experience in testing patients for NBLAs. We are itching to know so share your thoughts via a response to this blog, post a comment with the article itself on our website, or let us hear from you on our Facebook or Twitter sites.

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