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Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19.
J Allergy Clin Immunol Pract. 2021 Jul 19 [Online ahead of print]JA

Abstract

BACKGROUND

Coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe. Several comorbidities are associated with worse clinical outcomes. Antibiotic use is common in COVID-19 and penicillin (PCN) allergy can affect antibiotic choice and may influence COVID-19 outcomes.

OBJECTIVE

To investigate the impact of PCN allergy label on COVID-19 outcomes.

METHODS

For this retrospective, cohort study, a Web-based tool for population cohort research, TriNetX, was used to identify adult COVID-19 patients with and without PCN allergy label. The two cohorts were matched using 1:1 propensity score matching for baseline demographics and conditions associated with risk for severe COVID-19. The 30-day risks for hospitalization, acute respiratory failure, intensive care unit requirement, mechanical ventilation requirement, and mortality were then compared between groups. Because bacterial infection can drive alternative antibiotic regimens, additional analyses focused on patients without bacterial infection.

RESULTS

After propensity score matching, each cohort consisted of 13,183 patients. COVID-19 patients with PCN allergy had higher risks for hospitalization (risk ratio [RR] = 1.46; 95% confidence interval [CI], 1.41-1.52) acute respiratory failure (RR = 1.25; 95% CI, 1.19-1.31), intensive care unit requirement (RR = 1.20; 95% CI, 1.08-1.34), and mechanical ventilation (RR = 1.17; 95% CI 1.03-1.32) compared with patients without PCN allergy; however, there was no mortality difference (RR = 1.09; 95% CI, 0.96-1.23). Although the bacterial infection risk was higher in PCN allergic COVID-19 patients, exclusion of patients with bacterial infections yielded similar results.

CONCLUSIONS

Penicillin allergic patients have higher risk for worse COVID-19 outcomes and should be considered for risk mitigation strategies.

Authors+Show Affiliations

Section of Allergy, Asthma, and Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa. Electronic address: lkaminsky@pennstatehealth.psu.edu.Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, Hershey, Pa.Section of Allergy, Asthma, and Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa.Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, Hershey, Pa.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34293501

Citation

Kaminsky, Lauren W., et al. "Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19." The Journal of Allergy and Clinical Immunology. in Practice, 2021.
Kaminsky LW, Dalessio S, Al-Shaikhly T, et al. Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19. J Allergy Clin Immunol Pract. 2021.
Kaminsky, L. W., Dalessio, S., Al-Shaikhly, T., & Al-Sadi, R. (2021). Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19. The Journal of Allergy and Clinical Immunology. in Practice. https://doi.org/10.1016/j.jaip.2021.06.054
Kaminsky LW, et al. Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19. J Allergy Clin Immunol Pract. 2021 Jul 19; PubMed PMID: 34293501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19. AU - Kaminsky,Lauren W, AU - Dalessio,Shannon, AU - Al-Shaikhly,Taha, AU - Al-Sadi,Rana, Y1 - 2021/07/19/ PY - 2021/01/07/received PY - 2021/06/10/revised PY - 2021/06/29/accepted PY - 2021/7/23/pubmed PY - 2021/7/23/medline PY - 2021/7/22/entrez KW - COVID-19 KW - Drug allergy KW - Hospitalization KW - Mortality KW - Penicillin KW - Penicillin allergy KW - Respiratory failure KW - Severe acute respiratory syndrome coronavirus-2 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract N2 - BACKGROUND: Coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe. Several comorbidities are associated with worse clinical outcomes. Antibiotic use is common in COVID-19 and penicillin (PCN) allergy can affect antibiotic choice and may influence COVID-19 outcomes. OBJECTIVE: To investigate the impact of PCN allergy label on COVID-19 outcomes. METHODS: For this retrospective, cohort study, a Web-based tool for population cohort research, TriNetX, was used to identify adult COVID-19 patients with and without PCN allergy label. The two cohorts were matched using 1:1 propensity score matching for baseline demographics and conditions associated with risk for severe COVID-19. The 30-day risks for hospitalization, acute respiratory failure, intensive care unit requirement, mechanical ventilation requirement, and mortality were then compared between groups. Because bacterial infection can drive alternative antibiotic regimens, additional analyses focused on patients without bacterial infection. RESULTS: After propensity score matching, each cohort consisted of 13,183 patients. COVID-19 patients with PCN allergy had higher risks for hospitalization (risk ratio [RR] = 1.46; 95% confidence interval [CI], 1.41-1.52) acute respiratory failure (RR = 1.25; 95% CI, 1.19-1.31), intensive care unit requirement (RR = 1.20; 95% CI, 1.08-1.34), and mechanical ventilation (RR = 1.17; 95% CI 1.03-1.32) compared with patients without PCN allergy; however, there was no mortality difference (RR = 1.09; 95% CI, 0.96-1.23). Although the bacterial infection risk was higher in PCN allergic COVID-19 patients, exclusion of patients with bacterial infections yielded similar results. CONCLUSIONS: Penicillin allergic patients have higher risk for worse COVID-19 outcomes and should be considered for risk mitigation strategies. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/34293501/Penicillin_allergy_label_increases_risk_of_worse_clinical_outcomes_in_COVID-19. L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(21)00787-X DB - PRIME DP - Unbound Medicine ER -
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