title: Diagnosis of allergy against beta-lactams in primary care: prevalence and diagnostic criteria.
abstract: BACKGROUND
  Secondary care studies showed that a recorded allergy to beta-lactams could not be confirmed by valid allergy testing in >85% of cases. In daily practice, recorded beta-lactam allergies probably cause prescription of secondary choice antibiotics. This overrating of beta-lactam allergy hampers appropriate use of narrow spectrum antibiotic and generates unnecessary cost and bacterial resistance.
  
  
  OBJECTIVE
  To assess registration and over diagnosis of allergies against beta-lactams in Dutch primary care.
  
  
  METHODS
  A retrospective cohort study in 8288 primary care subjects was performed. Patients with recorded allergy were identified through International Classification for Primary Care coding. Signs and symptoms of the recorded allergic reaction and patient's characteristics were extracted from patient's files and patients were sent a questionnaire. The probability of allergy was based on a composite reference standard that was scored by two authors independently.
  
  
  RESULTS
  One hundred sixty-three subjects had a recorded allergy (2.0%). In 51.5% of cases, no characteristics of the recorded allergic reaction were reported in patients' medical files. Based on our composite reference standard, allergy was excluded in 19 subjects (11.7%). Risk factors for allergy registration were female gender, age <4 years, and the comorbidities-asthma, allergies and skin disorders.
  
  
  CONCLUSIONS
  The prevalence of recorded allergy against beta-lactam antibiotics in a large Dutch primary care centre was 2%. Due to lack of registration of accompanying signs and symptoms of the recorded allergy, this diagnosis is uncertain in most patients. Better documentation and classification by a screening algorithm of future possible allergic reactions to beta-lactams are needed in primary care.
authors: Julius Center for Health Sciences and Primary Care and.
authors: Odette A E
authors: OA
authors: Salden
authors: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Heike
authors: H
authors: Rockmann
authors: Julius Center for Health Sciences and Primary Care and.
authors: Theo J M
authors: TJ
authors: Verheij
authors: Julius Center for Health Sciences and Primary Care and b.d.l.broekhuizen@umcutrecht.nl.
authors: Berna D L
authors: BD
authors: Broekhuizen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology; D001249:Asthma / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D012871:Skin Diseases / Q000453:epidemiology; D055815:Young Adult; D047090:beta-Lactams / Q000009:adverse effects / Q000276:immunology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: Beta-lactams; The Netherlands.; hypersensitivity; prevalence; primary health care; probability; risk factors