Penicillin and Beta-lactam Antibiotic Allergies in Rheumatology: A Scoping Review

Self-reported allergies to penicillin and other beta-lactam antibiotics pose a public health challenge due to their association with broad-spectrum antibiotic overuse, increased health care costs and worse clinical outcomes. Of the general population, 10% to 25% are labeled as beta-lactam allergic, but fewer than 1% have beta-lactam antibiotic allergies as confirmed by testing. Patients with systemic autoimmune rheumatologic diseases (SARDs) may be more likely to be labeled, but little is known about beta-lactam allergy in this population. This scoping review characterizes (1) reported prevalence, (2) possible shared etiopathogenesis, (3) de-labeling strategies, and (4) clinical implications of beta-lactam allergy in SARDs.

This scoping review was guided by the Arksey and O'Malley 6-stage framework. A comprehensive search was conducted in MEDLINE, CINAHL, Embase, Web of Science, and Scopus. Articles containing original information on beta-lactam allergy status in patients with SARDs were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Of 9447 records identified, 20 met the inclusion criteria. In 16 studies reporting prevalence, beta-lactam antibiotic allergy labels were seen in 4.5% to 37% of patients. In the 2 studies evaluating de-labeling, only 0.5% to 4.4% had confirmed allergies. Immune dysregulation and frequent antibiotic exposure were cited as contributors to mislabeling. No studies directly evaluated clinical outcomes in relation to allergy status.

This scoping review identifies key gaps and opportunities for improving beta-lactam allergy evaluation in rheumatology patients. Further research is needed to define effective, safe de-labeling strategies tailored to patients with SARDs.