High prevalence of antibiotic allergies in cladribine-treated patients with hairy cell leukemia - lessons for immunopathogenesis and prescribing

• Published in: Leukemia & lymphoma Vol. 60; no. 14; pp. 3455 - 3460
• Main Authors: Meher-Homji, Zaal, Tam, Constantine S., Siderov, Jim, Seymour, John Francis, Holmes, Natasha E., Chua, Kyra Y. L., Phillips, Elizabeth J., Slavin, Monica A., Trubiano, Jason A.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 06-12-2019
• Subjects: allergy; antibiotics; cladribine; Hairy cell leukemia; maculopapular exanthem; allergy; Hairy cell leukemia; cladribine; antibiotics; maculopapular exanthem
• ISSN: 1042-8194; 1029-2403
• DOI: 10.1080/10428194.2019.1633640

The relationship between hematological malignancy and chemotherapy on the prevalence of antibiotic allergy label (AAL) is ill-defined. We performed a multicenter retrospective case-control study comparing AAL rates among cladribine-treated hairy cell leukemia (C-HCL) cases, non-HCL cladribine-treated controls (control-1), and fludarabine-treated controls (control-2). The prevalence of AALs in C-HCL patients was 60%, compared with control-1 (14%, p < .01) and control-2 patients (25%, p < .01). The predominant phenotype was maculopapular exanthem (92%). The drugs implicated in AAL causality in C-HCL patients included beta-lactams (81%), trimethoprim-sulfamethoxazole (58%), and allopurinol (69%). C-HCL patients demonstrate high rates of AAL, potentially due to immune dysregulation, impacting beta-lactam utilization.