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Article: Prevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong

TitlePrevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong
Authors
KeywordsDrug Hypersensitivity
Penicillin
Beta-Lactam
Issue Date2020
PublisherAmerican Medical Association. The Journal's web site is located at https://jamanetwork.com/journals/jamanetworkopen
Citation
JAMA Network Open, 2020, v. 3 n. 5, p. article no. e204199 How to Cite?
AbstractImportance: Allergy to β-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic- and region-specific sensitization patterns of skin testing for β-lactam antibiotic allergy are also unknown. Objective: To identify the prevalence, 1-year incidence, and sensitization patterns of β-lactam antibiotic allergy in patients in Hong Kong. Design, Setting, and Participants: This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (Hong Kong East, Hong Kong West, Kowloon Central, Kowloon East, Kowloon West, New Territories East, and New Territories West). All referrals to Queen Mary Hospital for β-lactam antibiotic allergy testing from January 1, 2018, to December 31, 2019, were also analyzed for sensitization patterns. Main Outcomes and Measures: Prevalence and cumulative incidence of β-lactam antibiotic allergy reported in Hong Kong, and sensitization patterns according to β-lactam antibiotic allergy skin testing. Results: Complete records of 7 184 271 unique patients were analyzed, with a men to women ratio of 1:1.2 and with a median age of 44 years. The prevalence of physician-reported β-lactam antibiotic allergy was 2.0%, and the cumulative incidence was 107 per 100 000 population. Of the 34 402 new drug allergies reported in 2018, 8032 (23.3%) were β-lactam antibiotic allergies. Three hundred fifty-five patients with reactions suggestive of β-lactam antibiotic allergy underwent skin testing, and only 49 (13.8%; 95% CI, 10.64%-17.90%) of them had positive test results. Of these 49 patients, 14 (28.6%; 95% CI, 18.35%-44.49%) had selective reaction and 35 (71.4%; 95% CI, 59.84%-85.27%) had nonselective reaction. The sensitization rate to either benzylpenicilloyl polylysine or a minor determinant (benzylpenicilloate) was 47.0% (n = 23; 95% CI, 34.85%-63.21%), with 10 patients monosensitized to benzylpenicilloyl polylysine only (20.4%; 95% CI, 11.74%-35.48%) and 5 to benzylpenicilloate only (10.2%; 95% CI, 4.45%-23.42%). Conclusions and Relevance: Results of this study suggest that patients in Hong Kong with β-lactam antibiotic allergy had much higher rates of monosensitization to benzylpenicilloyl polylysine and benzylpenicilloate, making these reagents essential in β-lactam antibiotic skin tests. Such a finding warrants future studies into whether this sensitization is specific to ethnicity or region.
Persistent Identifierhttp://hdl.handle.net/10722/283256
ISSN
2019 Impact Factor: 5.032
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLi, PH-
dc.contributor.authorYeung, HHF-
dc.contributor.authorLau, CS-
dc.contributor.authorAu, EYL-
dc.date.accessioned2020-06-22T02:54:13Z-
dc.date.available2020-06-22T02:54:13Z-
dc.date.issued2020-
dc.identifier.citationJAMA Network Open, 2020, v. 3 n. 5, p. article no. e204199-
dc.identifier.issn2574-3805-
dc.identifier.urihttp://hdl.handle.net/10722/283256-
dc.description.abstractImportance: Allergy to β-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic- and region-specific sensitization patterns of skin testing for β-lactam antibiotic allergy are also unknown. Objective: To identify the prevalence, 1-year incidence, and sensitization patterns of β-lactam antibiotic allergy in patients in Hong Kong. Design, Setting, and Participants: This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (Hong Kong East, Hong Kong West, Kowloon Central, Kowloon East, Kowloon West, New Territories East, and New Territories West). All referrals to Queen Mary Hospital for β-lactam antibiotic allergy testing from January 1, 2018, to December 31, 2019, were also analyzed for sensitization patterns. Main Outcomes and Measures: Prevalence and cumulative incidence of β-lactam antibiotic allergy reported in Hong Kong, and sensitization patterns according to β-lactam antibiotic allergy skin testing. Results: Complete records of 7 184 271 unique patients were analyzed, with a men to women ratio of 1:1.2 and with a median age of 44 years. The prevalence of physician-reported β-lactam antibiotic allergy was 2.0%, and the cumulative incidence was 107 per 100 000 population. Of the 34 402 new drug allergies reported in 2018, 8032 (23.3%) were β-lactam antibiotic allergies. Three hundred fifty-five patients with reactions suggestive of β-lactam antibiotic allergy underwent skin testing, and only 49 (13.8%; 95% CI, 10.64%-17.90%) of them had positive test results. Of these 49 patients, 14 (28.6%; 95% CI, 18.35%-44.49%) had selective reaction and 35 (71.4%; 95% CI, 59.84%-85.27%) had nonselective reaction. The sensitization rate to either benzylpenicilloyl polylysine or a minor determinant (benzylpenicilloate) was 47.0% (n = 23; 95% CI, 34.85%-63.21%), with 10 patients monosensitized to benzylpenicilloyl polylysine only (20.4%; 95% CI, 11.74%-35.48%) and 5 to benzylpenicilloate only (10.2%; 95% CI, 4.45%-23.42%). Conclusions and Relevance: Results of this study suggest that patients in Hong Kong with β-lactam antibiotic allergy had much higher rates of monosensitization to benzylpenicilloyl polylysine and benzylpenicilloate, making these reagents essential in β-lactam antibiotic skin tests. Such a finding warrants future studies into whether this sensitization is specific to ethnicity or region.-
dc.languageeng-
dc.publisherAmerican Medical Association. The Journal's web site is located at https://jamanetwork.com/journals/jamanetworkopen-
dc.relation.ispartofJAMA Network Open-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectDrug Hypersensitivity-
dc.subjectPenicillin-
dc.subjectBeta-Lactam-
dc.titlePrevalence, Incidence, and Sensitization Profile of β-lactam Antibiotic Allergy in Hong Kong-
dc.typeArticle-
dc.identifier.emailLi, PH: liphilip@HKUCC-COM.hku.hk-
dc.identifier.emailLau, CS: cslau@hku.hk-
dc.identifier.authorityLi, PH=rp02669-
dc.identifier.authorityLau, CS=rp01348-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1001/jamanetworkopen.2020.4199-
dc.identifier.pmid32374398-
dc.identifier.pmcidPMC7203606-
dc.identifier.scopuseid_2-s2.0-85084328121-
dc.identifier.hkuros310335-
dc.identifier.volume3-
dc.identifier.issue5-
dc.identifier.spagearticle no. e204199-
dc.identifier.epagearticle no. e204199-
dc.identifier.isiWOS:000534036000004-
dc.publisher.placeUnited States-
dc.identifier.issnl2574-3805-

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