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

Objective: 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. Methods: 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). Results: 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. Conclusion: 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.