Risk factors of beta-lactam anaphylaxis in Korea: A 6-year multicenter retrospective adult case-control study

Chan Sun Park; Min-Suk Yang; Dong-Yoon Kang; Hye Jung Park; So-Young Park; Young-Hee Nam; Sujeong Kim; Jae-Woo Jung; Hye-Kyung Park; Hye-Ryun Kang; Drug Allergy Work Group of KAAACI

doi:10.1016/j.waojou.2021.100580

Risk factors of beta-lactam anaphylaxis in Korea: A 6-year multicenter retrospective adult case-control study

World Allergy Organ J. 2021 Sep 8;14(9):100580. doi: 10.1016/j.waojou.2021.100580. eCollection 2021 Sep.

Authors

Affiliations

¹ Department of Internal Medicine, Inje University, Haeundae Paik Hospital, Busan, South Korea.
² Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
³ Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, South Korea.
⁴ Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea.
⁶ Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
⁷ Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
⁸ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
⁹ Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine, Busan, South Korea.
¹⁰ Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

Background: Beta-lactams (BLs) are commonly used antibiotics and leading causative agents of drug-induced anaphylaxis. Few studies on the culprit drugs and risk factors of BL-induced anaphylaxis are available. Our goal was to evaluate the culprit drugs and compare the risk factors in patients with BL-induced anaphylaxis to matched tolerant controls in a hospital setting.

Methods: We retrospectively enrolled all patients who developed anaphylaxis from intravenous BL during hospitalization from 9 Korean hospitals. We compared clinical parameters between patients with BL-induced anaphylaxis and 4-fold BL-tolerant controls matched by age, sex, BL use, and the purpose of BL administration.

Results: Seventy-four cases of BL-induced anaphylaxis and 296 BL-tolerant controls were enrolled. Cephalosporin accounted for 77% of total BL-induced anaphylaxis, and the top derivatives were ceftriaxone (23.0%), cefazedone (10.8%), and cefbuperazone (9.5%). Among penicillin derivatives, piperacillin (16.2%) was the most common, followed by ampicillin (2.7%). History of drug allergy (odds ratio [OR], 19.91; 95% confidence interval [CI] 5.33-74.44), previous exposure to the causative BL (OR, 7.71; 95% CI, 1.62-36.76), and concurrent administration of angiotensin-converting enzyme inhibitors (ACEIs) (OR, 5.97; 95% CI, 1.28-27.91) were independent risk factors associated with BL-induced anaphylaxis. Food allergy (OR, 13.93; 95% CI 1.31-148.9) and previous exposure to BL (OR, 6.59; 95% CI, 1.30-33.31) were identified as risk factors for cephalosporin-induced anaphylaxis.

Conclusions: To prevent BL-induced anaphylaxis, attention should be paid to histories of drug or food allergy, previous exposure to BLs, and ACEI use. The risk factors and clinical outcomes might vary according to the BL classes.

Keywords: Anaphylaxis; Angiotensin-converting enzyme inhibitors; Beta-lactams; Case-control studies; Cephalosporin; Drug hypersensitivity.