Characterizing the Prevalence of Reported Beta-Lactam Allergy in Pediatric Oncology Patients

RATIONALE: Beta-lactam allergy is the most commonly reported medication allergy. However, upon thorough evaluation, many of these patients are found not to be allergic. Thus, a systematic approach to the evaluation of such documented medication allergy is necessary especially in the Pediatric Oncology population as these patients are vulnerable to infection requiring beta-lactam treatment. Alternatives are significantly more expensive than first-line antimicrobial regimens, have less data to support use and have more potential for side effects.

METHODS: Retrospective chart review design using REDCap database. Inclusion criteria involved Hematology/Oncology patients at the Cleveland Clinic who were diagnosed with any form of cancer between January 2007-July 2017. Ages included were from 0-21 years of age. Those who have been diagnosed with any beta-lactam allergy were evaluated for age of diagnosis, type of reaction noted and if a challenge or skin testing was performed. Data are presented as number (or percent), median (IQR), or mean ± SD, as appropriate.

RESULTS: Of 250 Oncology patients reviewed, 68 (or 27%) have a documented beta-lactam allergy. Of which 208 (or 83%) have the reaction noted as rash or hives. Only 3 (or 1%) have documented anaphylaxis. Importantly, 218 (or 87%) have never been tested or challenged to ensure true allergy.

CONCLUSIONS: Beta-lactam allergy documentation is not always clear as assumed allergies may be secondary to other mechanisms. Considering the implementation of a protocol for testing or challenging such allergies in vulnerable populations such as Pediatric Oncology patients may be useful in preventing the use of alternative and inappropriate antibiotics.