Alergia a Betalactámicos a partir de los 60 años

La mayoría de las personas que se consideran alérgicas a betalactámicos (BLs) pueden tolerar estos medicamentos debido a un error en el diagnóstico inicial, la pérdida espontánea de sensibilidad a estos antibióticos con el tiempo o la disminución de la sensibilización relacionada con la edad. Como consecuencia del falso diagnóstico estos pacientes serían tratados con antibióticos menos efectivos, con más efectos secundarios y más costosos para los sistemas sanitarios. Los objetivos de esta investigación fueron: Estimar la prevalencia real de alergia a BLs en pacientes mayores de 60 años que habían sido etiquetados como alérgicos a este grupo de antibióticos, determinar si aquellos pacientes con diagnóstico confirmado en el pasado eran capaces de tolerar BLs en el momento actual y demostrar una reducción de costes en el tratamiento con antibióticos después de desestimar el diagnóstico de alergia a los BLs en pacientes >80 años ingresados en el Hospital General Universitario de Alicante. Pacientes y métodos: Los pacientes alérgicos a BLs se dividieron en dos grupos, el grupo A (de 60 a 79 años) y B (de ≥ 80 años). La historia clínica, los resultados de las pruebas cutáneas (PC), las pruebas de exposición controlada con medicamentos (PECM) y el retestamiento se usaron para clasificar a los pacientes como alérgicos (con reacciones inmediatas o reacciones no inmediatas), o como no alérgicos. Comparamos las entidades clínicas, medicamentos implicados y resultado final por grupo etario. Se calculó la media de los costes de los antibióticos no betalactámicos en aquellos pacientes mayores de 80 años que recibieron este tipo de tratamiento durante el ingreso hospitalario y se comparó con la media de los costes que hubiera tenido el tratamiento de la misma enfermedad con antibióticos BLs. Resultados: De 1362 casos evaluados, se realizó el estudio alergológico a 565 pacientes. La piel fue el órgano involucrado con más frecuencia. La anafilaxia, las PECM positivas y las reacciones por la cadena lateral fueron más frecuentes en el grupo A (p <0,01). La penicilina y los determinantes clásicos de bencilpenicilina (PPL y MDM) fueron los desencadenantes más frecuentes en el grupo B (p <0,01). La resensibilización ocurrió en pocos participantes. El 83,6% de los pacientes mayores de 80 años ingresados en el Hospital General Universitario de Alicante necesitaron antibióticos durante el ingreso hospitalario y el coste de los antibióticos prescritos (no betalactámicos) resultó mayor. Conclusión: El riesgo de alergia a los BLs disminuye con la edad y un historial de anafilaxia por estos antibióticos es un predictor de resultados positivos en las PC. Las reacciones por inmunoglobulina E y por linfocitos T pueden desaparecer en ancianos, lo que derivaría en tolerancia a estos antibióticos. El coste de los antibióticos prescritos para pacientes con alergia a BLs resultó mayor. ABSTRACT Background: People who thought to have an allergy to betalactams may tolerate the drugs in subsequent exposures due to initial false labeling of allergies, the spontaneous loss of sensitivity to BLs over time or age-related decline in sensitization. As a result, they may be treated with less appropriate antibiotics, causing more side effects and entailing increased costs for health systems. The goals of this investigation were: Estimate the real prevalence of betalactam allergy in patients over 60 years, previously labeled as allergic to BLs; determine if those patients with a confirmed diagnosis in the past were able to tolerate BLs at the present time; and demonstrate cost reduction in antibiotic treatment after underestimating the diagnosis of betalactam allergy in patients >80 years admitted to the hospital. Patients and methods: Patients allergic to BLs were divided into group A (aged 60–79 years) and B (aged ≥80 years). Clinical history, skin testing, drug challenge tests (DCT) and restesting were used to classify participants as allergic with immediate reactions, nonimmediate reactions, or not allergic. We compared clinical entities, drugs involved, and final outcome by age group. The average cost of non-betalactam antibiotics for patients older than 80 years who required them during hospital admission was calculated and compared with the average cost of treating the same disease with BLs antibiotics. Results: Of 1362 cases evaluated, 565 underwent an allergological study. The skin was the most common organ involved. Anaphylaxis, positive DCT and side chain reactions were more frequent in group A (p<0.01). Classical benzylpenicillin determinants (benzylpenicilloyl and/or minor determinant mixture) were more frequent triggers in group B (p< 0.01). Resensitization occurred in very few participants. 83.6% of patients older than 80 years admitted to the General University Hospital of Alicante required antibiotics during hospital admission and the cost of prescribed antibiotics (non-betalactams) was higher. Conclusion: The risk for allergy to BLs decreases with age and a history of anaphylaxis by BLs is a predictor of positive results in skin tests. Both immunoglobin E (IgE) and T-cell–mediated responses can disappear in elderly people, who can develop tolerance to these antibiotics. These results are of clinical relevance to patients who need to be treated with antibiotics from this family. The cost of prescribed antibiotics for patients with BLs allergy was higher

Subjects develop tolerance to Pru p 3 but respiratory allergy to Pru p 9: A large study group from a peach exposed population.

Peach tree allergens are present in fruit, pollen, branches, and leaves, and can induce systemic, respiratory, cutaneous, and gastrointestinal symptoms. We studied the capacity of peach fruit/Pru p 1, Pru p 3, Pru p 4, Pru p 7 and peach pollen/Pru p 9 for inducing symptoms following oral or respiratory exposure in a large group of subjects. We included 716 adults (aged 21 to 83 y.o.) exposed to peach tree pollen and fruit intake in the study population. Participants completed a questionnaire and were skin tested with a panel of inhalant and food allergens, including peach tree pollen, Pru p 9 and peach fruit skin extract. Immunoglobulin E antibodies (SIgE) to Pru p 1, Pru p 3, Pru p 4 and Pru p 7 were quantified. Sensitised subjects underwent oral food challenge with peach fruit and nasal provocation test with peach tree pollen and Pru p 9. The prevalence of sensitisation to peach fruit was 5% and most of these had SIgE to Pru p 3, with a very low proportion to Pru p 4 SIgE and no SIgE to Pru p 1 and Pru p 7. In only 1.8%, anaphylaxis was the clinical entity induced. Cases with positive skin tests to peach and SIgE to Pru p 3 presented a good tolerance after oral challenge with peach fruit. The prevalence of skin sensitisation to peach tree pollen was 22%, with almost half recognising Pru p 9. This induced respiratory symptoms in those evaluated by nasal provocation. In a large population group exposed to peach fruit and peach tree pollen, most individuals were tolerant, even in those with SIgE to Pru p 3. A positive response to Pru p 9 was associated with respiratory allergy