Patel Nisha B, Cojuc-Konigsberg Gabriel, Garcia-Guaqueta Danna, Shah Divya, Balasubramaniam Darshana, Mahajan Avanika, Shakuntulla Fnu, Gerberi Danielle, Cuervo-Pardo Lyda, Park Miguel A, Pongdee Thanai, Jerschow Elina, Joshi Avni, Wang Zhen, Gonzalez-Estrada Alexei, Chiarella Sergio E
Division of Allergy and Immunology, Washington University in St Louis, St Louis, Mo.
Medical School, Faculty of Health Sciences, Universidad Anahuac, Mexico City, Mexico.
J Allergy Clin Immunol Pract. 2025 Jan;13(1):155-166.e11. doi: 10.1016/j.jaip.2024.10.031. Epub 2024 Nov 2.
β-Lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of β-lactam antibiotics.
This systematic review and meta-analysis aimed to identify sex- and gender-based differences in the prevalence of immediate β-lactam allergy.
We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library between 2013 and 2023. Patients with a documented β-lactam allergy who underwent allergy testing with skin testing, oral drug challenge, or serum-specific IgE were included. We quantitatively assessed sex- and gender-based differences in β-lactam allergy with meta-analysis.
We included 69 primary studies assessing 53,989 participants from outpatient and inpatient cohorts. A total of 7,558 patients had a confirmed β-lactam allergy. There was no difference in the prevalence of positive β-lactam allergy test between males and females. Subgroup analysis of studies that performed oral challenges showed a higher risk of β-lactam allergy in females compared with males (relative risk = 1.40; 95% CI, 1.18-1.66; P < .001; I = 77.8%). Finally, there was a higher proportion of females (64.8%) than males enrolled in β-lactam allergy studies.
Our findings suggest both sex-based and gender-based differences in the prevalence of immediate β-lactam allergy. Biological factors such as sex hormones and gender-based behaviors including increased health care use may contribute to higher rates of β-lactam allergy diagnosis in females.
β-内酰胺类是报告中引起药物过敏反应最常见的抗生素类别。既往文献表明，住院和门诊女性患者中青霉素药物过敏的患病率有所增加。然而，关于整个β-内酰胺类抗生素类别，性别因素的影响尚未得到充分描述。
本系统评价和荟萃分析旨在确定速发型β-内酰胺过敏患病率的性别差异。
我们在2013年至2023年期间对Ovid MEDLINE/PubMed、Embase、Web of Science、Scopus和Cochrane图书馆进行了电子检索。纳入有记录的β-内酰胺过敏且接受过皮肤试验、口服药物激发试验或血清特异性IgE过敏检测的患者。我们采用荟萃分析定量评估β-内酰胺过敏的性别差异。
我们纳入了69项评估来自门诊和住院队列的53989名参与者的主要研究。共有7558例患者确诊为β-内酰胺过敏。男性和女性β-内酰胺过敏试验阳性的患病率没有差异。进行口服激发试验的研究亚组分析显示，女性β-内酰胺过敏风险高于男性（相对风险=1.40；95%CI，1.18-1.66；P<.001；I=77.8%）。最后，参与β-内酰胺过敏研究的女性比例（64.8%）高于男性。
我们的研究结果表明，速发型β-内酰胺过敏的患病率存在基于性别的差异和基于社会性别的差异。诸如性激素等生物学因素以及包括医疗保健使用增加在内的基于社会性别的行为可能导致女性β-内酰胺过敏诊断率较高。
