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Sex and gender differences in prevalence of immediate beta-lactam allergy

Published online November 2, 2024

Beta-lactams are the most common antibiotic class reported to cause allergic drug reactions. Previous literature suggests an increased prevalence of penicillin drug allergy in female patients in both inpatient and outpatient settings. However, the effects of sex and gender have not been well characterized regarding the entire class of beta-lactam antibiotics.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Patel et al. conducted a systematic review and meta-analysis to identify sex and gender-based differences in the prevalence of immediate beta-lactam allergy. Sex was defined as biological variable determined by differential organization of chromosomes, while gender was defined as the behaviors, roles, and identities determined by society and culture. An electronic literature search was performed for studies between 2013-2023 which assessed patients with confirmed beta-lactam allergy and reported results by sex. Diagnostic allergy tests included skin prick test, intradermal test, serum-specific immunoglobulin E (IgE) quantification, and/or oral challenge. The meta-analysis included 69 primary studies, assessing 53,989 participants from outpatient and inpatient cohorts. 7,558 patients had a confirmed beta-lactam allergy.

This study found no difference in the prevalence of positive beta-lactam allergy test between sexes when assessing studies that performed both skin tests and oral challenges (RR 1.0, 95% CI 0.99-1.02, p =1.000, I2 = 0.0%). However, sub-group analysis of studies that performed oral challenges did show a higher risk of beta-lactam allergy in females than males (RR 1.40, 95% CI 1.18-1.66, p < 0.001, I2 =77.8%). There was also a higher proportion of females (64.8%) than males enrolled in beta-lactam allergy studies (95% CI 0.61-0.65, p < 0.001, I2 = 94.0%) and a higher number of total overall confirmed beta-lactam allergies in the literature for women (95% CI 0.61-0.69, p < 0.001, I2 = 82.6%). These findings suggest both sex-based and gender-based differences in the prevalence of immediate beta-lactam allergy, which may be influenced by both biological factors such as sex hormones, as well as behavioral factors such as healthcare utilization and exposure to allergens.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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