Original Title: Allergie présumée aux pénicillines – Évaluation des risques pour un usage optimal et sécuritaire des bêta-lactamines

Authors' objectives: From 2017 to 2019, INESSS conducted works that led to the development of an algorithm for reintroducing betalactams based on the severity of suspected allergic reactions, as well as two systematic reviews with meta-analyses on the risks of cross-reactions between penicillins and cephalosporins/carbapenems. Changes in clinical and scientific data raised concerns about the relevance of the initial algorithm, prompting INESSS to revise its recommendations to adapt them to current practices and the principles of antibiotic stewardship.

Authors' results and conclusions: RESULTS: Since the initial publication in 2017, guidelines surrounding the management of penicillin allergies have evolved toward a more nuanced approach, focusing on individualized assessment of allergic risks. The current works emphasize a more rigorous stratification of allergic risk based on three factors: the probability of a true allergy, the risk of recurrence upon re-exposure, and the risk of cross-reactions with another beta-lactam. CONCLUSION: In 2017, INESSS recommended a series of actions to structure documentation, strengthen clinical knowledge, and support the training of healthcare professionals in order to improve the quality and safety of care. However, these recommendations have not been fully implemented. To this end, it is suggested that the ministère de la Santé et des Services sociaux (MSSS) implement the INESSS recommendation made in 2017 concerning the integration of the “ Allergie et intolérance ” section into the Dossier santé Québec.

Authors' recommendations: At the end of the works and following an iterative process with the members of the consultative committee, during which scientific data, information and recommendations drawn from the literature consulted, contextual elements and the perspectives of various stakeholders consulted were triangulated, a series of clinical recommendations were formulated. These recommendations, presented in the main body of the report and summarized in the associated clinical tools, will also be gradually incorporated into all of INESSS's guides for optimal use of antibiotic therapy.

Authors' methods: For these works, the evaluation questions were formulated to cover population-based and clinical dimensions while also considering organisational, economic, and sociocultural dimensions, as well as ethical and environmental issues as presented in the INESSS Énoncé de principes et fondements éthiques. The overall approach combined an update of the 2017 works with a newly conducted systematic review. A systematic search of scientific literature published between 2018 and 2024 was conducted in four databases, in addition to a manual search of gray literature. Targeted source data verification of this literature was conducted until April 2025. Three methodological components were carried out: an update of the two systematic reviews with metaanalyses on cross-reactions to beta-lactams, a systematic review of clinical recommendations published since 2017, and a review of the performance of penicillin allergy risk evaluation tools. The systematic reviews were conducted in accordance with INESSS standards. The analysis and synthesis of all the data collected were carried out with a view to contextualizing the practice in Quebec.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/allergie-aux-penicillines.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)