Allergic reactions to ampicillin. Studies on the specificity and selectivity in subjects with immediate reactions

Romano, Antonino; Torres, Marı́a José; Fernández, J.; Vega, José M.; Mayorga, C.; Garcı́a, J.J.; Blanca, Miguel

doi:10.1111/j.1365-2222.1997.tb02987.x

Cited by 36 publications

(28 citation statements)

References 20 publications

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“…Similarly, because we did not test for a wide variety of penicillin side-chain reactions, we can only draw conclusions about reactions caused by the major and minor determinants of penicillin. However, there is considerable crossreactivity between ampicillin and these determinants [18].…”

Section: Discussionmentioning

confidence: 99%

Introduction of a Practice Guideline for Penicillin Skin Testing Improves the Appropriateness of Antibiotic Therapy

et al. 2001

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We hypothesized that the introduction of a practice guideline for penicillin skin testing would increase the appropriateness of skin testing and reduce antibiotic costs for patients with a history of penicillin allergy who have infections caused by penicillin-susceptible pathogens. We measured the appropriateness of skin testing and daily antibiotic costs before and after the introduction of a guideline for penicillin skin testing. For patients who had negative results of skin testing and were subsequently treated with a penicillin instead of an alternative antibiotic, we calculated the difference between the actual costs and the projected costs of continuing alternative antibiotics without skin testing. After the guideline was introduced, appropriateness of skin testing increased from 17% to 64%, but daily antibiotic costs did not change. For patients who had negative results of skin testing and who were subsequently treated with a penicillin, there was no difference between actual costs and the projected costs if they had not been skin tested. We conclude that introduction of a guideline for penicillin skin testing increases the percentage of eligible patients who have a skin test, and it does so without increasing costs.

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Section: Discussionmentioning

confidence: 99%

Introduction of a Practice Guideline for Penicillin Skin Testing Improves the Appropriateness of Antibiotic Therapy

et al. 2001

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“…A DP of tetracycline, i.e., epianyhdrotetracycline, causes Fanconi's syndrome leading to renal failure [5]. Another example is that of polymeric DPs in aminopencillins that have been attributed to cause allergenicity and not the drugs themselves [6,7]. The most recent case is the presence of oversulfated chondroitin sulfate in heparin samples that caused allergenic reactions and over 100 deaths [8].…”

Section: The Focus On Impurities and Degradation Productsmentioning

confidence: 98%

A critical review on the use of modern sophisticated hyphenated tools in the characterization of impurities and degradation products

Singh

Handa

Narayanam

et al. 2012

Journal of Pharmaceutical and Biomedical Analysis

184

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“…A recent study of 48 Italian subjects with IgE-mediated allergic reactions to ampicillin found that only three (6.25 %) cases were selective reactors [35]. IgE allergic selective reactions to penicillin V [36][37][38], cloxacillin [39,40], and piperacillin [41,42] have also been reported for a limited number of cases.…”

Section: Penicillin As An Alternative Treatmentmentioning

confidence: 99%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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Opinion statementIt was originally thought that, as all betalactams share a four-member ring, they would cross-react, and so the classical recommendation was for allergic patients to avoid all betalactams. However, later studies found that some individuals selectively responded to one betalactam only and tolerated others. This was shown to be more frequent than initially thought, and this finding has led to a change from the initial recommendations of complete avoidance. Selective responses to amoxicillin are mainly due to recognition of the side chain structure, making benzylpenicillin a safe alternative. These amoxicillin-selective responders comprise up to 55 and 90 % of patients with immediate allergic reactions to amoxicillin and amoxicillin-clavulanic, respectively. Additionally, more than 85 % of penicillin-allergic patients can tolerate cephalosporins with different R 1 side chains, decreasing to 65 % if the side chain is identical. It is known that third and fourth generation cephalosporins are well tolerated by penicillin-allergic patients, probably because their chemical structures differ more from penicillins that those from the first generation. In patients with IgE-mediated allergic reactions to cephalosporins, penicillins can be an alternative treatment in up to 75 % of cases. Moreover, 40 % of patients primarily sensitized to a given cephalosporin also react to others, which might be because some cephaloporins have the same (ceftriaxone and cefotaxime) or very similar (ceftriaxone and cefuroxime) side chain structures. Finally, carbapenems and monobactams are good alternative for patients with penicillin and/or cephalosporin allergy because cross-reactivity occurs in G1 % of these cases. For all betalactams, tolerance is higher in T-cell-mediated reactions than IgE-mediated. These results show that alternative treatments for infectious disease are available to patients with allergic reactions to betalactams, from within the same group of antibiotics. Nevertheless, this general rules need to be analyzed patient by patient, and skin tests and graded challenge with the betalactam that is going to be administered are recommended. Keypoints• Patients with IgE-or T-cell-mediated allergy to betalactams can have selective reactions, specific to one betalactam with good tolerance to others, or be crossreactive, recognizing several different chemically related betalactams.• The percentage of selective reactions to the different betalactam compounds is higher than previously reported and patients should be studied in order to increase the treatment options available.

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Allergic reactions to ampicillin. Studies on the specificity and selectivity in subjects with immediate reactions

Cited by 36 publications

References 20 publications

Introduction of a Practice Guideline for Penicillin Skin Testing Improves the Appropriateness of Antibiotic Therapy

Introduction of a Practice Guideline for Penicillin Skin Testing Improves the Appropriateness of Antibiotic Therapy

A critical review on the use of modern sophisticated hyphenated tools in the characterization of impurities and degradation products

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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