Shapiro Ben David Shirley, Kantor Avner, Hemo Beatriz, Donskoi Swetlana, Baruch-Gez Sharon, Rahamim-Cohen Daniella, Shamir-Stein Na'ama, Bar-Rason Edna, Hershko Alon Y
Maccabi Healthcare Services, Tel Aviv, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Allergy Clin Immunol Glob. 2025 Aug 28;4(4):100565. doi: 10.1016/j.jacig.2025.100565. eCollection 2025 Nov.
Penicillin allergy (PA) is the most documented drug allergy and is overdiagnosed. Data on medical aspects and expenditure outcomes of PA in the outpatient setting are important for planning delabeling programs.
We sought to characterize the features of PA on a nationwide level and associated burden on the health care system.
This is a retrospective, matched cohort study conducted on members of a single health maintenance organization. Medical records of those with documented PA in 2022 were compared with those of matched subjects without allergy based on age group, sex, ethnicity, socioeconomic status, and comorbidities. Outcomes included physician encounters, hospitalizations, death events, antibiotic purchases, and costs.
From a database of 2,602,110 individuals, 96,675 (3.7%) subjects with documented PA were included. Most were females (63.3%), mean age 47.3 ± 22 years, and had medium to high socioeconomic status (85.6%). PA was associated with more encounters with primary care physicians (odds ratio [OR], 1.42; 95% CI, 1.38-1.46; < .001), pediatricians (OR, 1.1; 95% CI, 1.07-1.14; < .001), and secondary care physicians (OR, 1.21; 95% CI, 1.19-1.24; < .001), and increased hospitalizations (OR, 1.12; 95% CI, 1.07-1.17; < .001). Death events were similar in both groups. PA was associated with increased antibiotic purchases per patient (average, 0.93 ± 1.79 vs 0.8 ± 1.58; < .001) at higher costs (8.91 USD vs 6.03 USD, < .01). It exhibited increased use of clindamycin (OR, 5.66; 95% CI, 5.38-5.95; < .001), macrolides (OR, 4.20; 95% CI, 4.08-4.32; < .001), and quinolones (OR, 1.50; 95% CI, 1.44-1.55; < .001).
Reported PA is associated with an increased burden on health care resources but not increased mortality. PA delabeling strategies should improve antibiotic use and costs.
青霉素过敏（PA）是记录最为详尽的药物过敏，且存在过度诊断的情况。门诊环境中PA的医学方面及支出结果数据对于规划去标签化项目很重要。
我们试图在全国范围内描述PA的特征以及其对医疗保健系统造成的相关负担。
这是一项针对单一健康维护组织成员开展的回顾性匹配队列研究。将2022年有PA记录者的病历与基于年龄组、性别、种族、社会经济地位和合并症匹配的无过敏受试者的病历进行比较。结果包括医生诊疗、住院、死亡事件、抗生素购买情况及费用。
在一个包含2602110人的数据库中，纳入了96675名（3.7%）有PA记录的受试者。大多数为女性（63.3%），平均年龄47.3±22岁，社会经济地位为中高（85.6%）。PA与更多地就诊于初级保健医生（比值比[OR]，1.42；95%置信区间[CI]，1.38 - 1.46；P <.001）、儿科医生（OR，1.1；95% CI，1.07 - 1.14；P <.001）和二级保健医生（OR，1.21；95% CI，1.19 - 1.24；P <.001）相关，且住院次数增加（OR，1.12；95% CI，1.07 - 1.17；P <.001）。两组的死亡事件相似。PA与每位患者抗生素购买量增加相关（平均，0.93±1.79对比0.8±1.58；P <.001），成本更高（8.91美元对比6.03美元，P <.01）。它表现为克林霉素使用增加（OR，5.66；95% CI，5.38 - 5.95；P <.001）、大环内酯类药物（OR，4.20；95% CI，4.08 - 4.32；P <.001）和喹诺酮类药物（OR，1.50；95% CI，1.44 - 1.55；P <.001）。
报告的PA与医疗保健资源负担增加相关，但与死亡率增加无关。PA去标签化策略应改善抗生素使用和成本。
