Can Beta-Lactam Allergy De-Labeling Strategies Safely Empower Geriatric Care?

Abstract

Background: Drug allergies constitute a significant health concern among the elderly, with beta-lactam (BL) antibiotics among the most frequently implicated agents. Nevertheless, data regarding the safety and efficacy of BL allergy de-labeling in this population remain scarce. This study aimed to evaluate the safety and efficacy of BL allergy assessment in a cohort of geriatric patients carrying BL allergy labels. Methods: We conducted a retrospective study, including patients aged >65 years who were referred for BL allergy evaluation at the Allergy Unit of Meir Medical Center. Patients underwent comprehensive anamnesis, skin testing, and, when indicated, oral challenge. Those successfully de-labeled were followed longitudinally to assess subsequent BL use and clinical outcomes. Results: Between 2009 and 2019, 166 elderly patients with suspected BL allergies were evaluated. A BL allergy was ruled out in 145 patients (87.3%). Sixteen patients (9.6%) were diagnosed with immediate-type hypersensitivity, 2.4% of patients had severe delayed-type hypersensitivity reactions, and one patient (0.6%) had a benign rash. The evaluation process was safe, with no severe reactions occurring during oral challenges, and no patient required hospitalization or epinephrine administration. A long-term follow up was available for 106 patients; among them, 38 (35.8%) received subsequent treatment with the previously suspected BL agent, without any reports of immediate or severe delayed reactions. Conclusions: Beta-lactam allergy de-labeling is safe and effective in the elderly and supports the critical role of allergy evaluation in this population. Enhanced awareness and implementation of de-labeling protocols in geriatric patients are warranted.