Patients with penicillin allergy at higher risk for worse COVID-19 outcomes

Patients with penicillin allergy had a higher risk for worse COVID-19 outcomes, according to study results published in The Journal of Allergy and Clinical Immunology: In Practice.

These outcomes include hospitalization, ICU requirement, acute respiratory failure and mechanical ventilation. However, there were no differences in mortality risk between those with and without penicillin allergy, researchers noted.

“COVID-19 ranges from asymptomatic to severe. Several comorbidities are associated with worse clinical outcomes. Antibiotic use is common in COVID-19 and penicillin allergy can impact antibiotic choice and may influence COVID-19 outcomes,” Lauren W. Kaminsky, MD, PhD, researcher in the section of allergy, asthma and immunology in the department of medicine at Penn State College of Medicine, and colleagues wrote.

Kaminsky and colleagues sought to assess the effect of penicillin allergy on outcomes of patients with COVID-19. They used a web-based tool to identify adults with COVID-19 with (n = 13,183) and without (n = 13,183) penicillin allergy and matched the two cohorts 1:1 for baseline demographics and conditions associated with risk for severe COVID-19. Researchers compared 30-day hospitalization risk, acute respiratory failure, ICU requirement, mechanical ventilation requirement and mortality between the two groups.

Results showed patients with penicillin allergy had a higher risk for hospitalization (RR = 1.46; 95% CI, 1.41-1.52), acute respiratory failure (RR = 1.25; 95% CI, 1.19-1.31), ICU requirement (RR = 1.2; 95% CI, 1.08-1.34) and mechanical ventilation (RR = 1.17; 95% CI, 1.03-1.32).

A slightly higher mortality risk in penicillin-allergic patients compared with patients without penicillin allergy during a 30-day observation period did not reach statistical significance (4.06% vs. 3.73%; RR = 1.09; 95% CI, 0.96-1.23).

Results of additional analyses on patients without bacterial infection — which can drive alternative antibiotic regimens — showed that although bacterial infection risk was higher among those with penicillin allergy, exclusion of those with bacterial infection led to similar results, according to the researchers.

“Patients with penicillin allergy could be prioritized as a higher-risk group for COVID-19 for development of risk mitigation strategies, including antibiotic stewardship programs to minimize unnecessary antibiotic use in these patients,” Kaminsky and colleagues wrote.