Considerable heterogeneity in the management approaches to beta-lactam allergies in real-life practice: Results of a nationwide survey from Turkey.

Abstract

Beta-lactams (BLs) are common elicitors of drug hypersensitivity reactions. This study evaluated current practices of allergists in the management of BL allergy and investigated differences in clinical approaches in Turkey. A web-based survey was used to assess how allergy specialists manage hypersensitivity reactions to BLs. Information was collected on diagnostic tests used for BL allergy, skin and drug provocation test (DPT) protocols, risk stratification, management approaches in specific clinical scenarios, and limitations in clinical practice. A total of 172 allergy specialists (92 pediatric and 80 adult allergists) from 70 centres were enrolled. Only 50 (29.1%) respondents were able to perform skin tests using a complete panel including penicillin determinants, whereas 23.3% tested only with the causative drugs. Remarkable variations exist in DPT protocols regarding number of steps, target doses, and total duration. The severity (96.5%), morphology (69.8%), and chronology (58.7%) of the reaction, and time elapsed since the reaction (51.7%) were identified as key features for risk stratification. Clinical practices for specific cases with different risk profiles were quite heterogeneous. Pediatric allergists more frequently perform direct DPTs in low-risk BL reactions (p < .05). Adult allergists more often perform drug tests to provide safe alternatives, particularly in high-risk reactions (p < .05). 44.2% of allergists preferred to perform a retest after an initial negative workup. Participants emphasized the need for updated educational activities, access to skin test reagents, and the application of standardized protocols. This nationwide study revealed considerable variability in allergists' clinical practices regarding the management of BL allergy. The implementation of standardized algorithms improves consistency in real-life practice.