Allergic reactions to penicillins and cephalosporins: diagnosis, assessment of cross-reactivity and management

Blanca‐López, Natalia; Jiménez-Rodriguez, Teodorikez Wilfox; Somoza, María Luisa; Gómez, Enrique; Al‐Ahmad, Mona; Blanca, Miguel

doi:10.1080/1744666x.2019.1619548

Cited by 13 publications

(18 citation statements)

References 118 publications

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“…On the other hand, we observed many patients in the 60–79-year-old group with BL-selective reactions to the side chain14,41,42 due to the more frequent prescription and use of amoxicillin, amoxicillin/clavulanic and ampicillin than BP. These patients reacted exclusively to amoxicillin, ampicillin or amoxicillin/clavulanic acid but were negative to both penicillin and its major and minor determinants 40,43. Positivity to ampicillin in our study was probably due to cross-reactivity with amoxicillin, as reported previously 44.…”

Section: Discussionsupporting

confidence: 86%

“…Most participants showed good tolerance to penicillins and other BLs like cephalosporins (ceftriaxone, cefazoline, cefotaxime, cefuroxime). The natural loss of sensitization is one possible explanation for these findings, as this has been reported to occur more quickly in side chain-specific reactions like those to amoxicillin or cephalosporins 28,42,43. In contrast, this phenomenon occurs more slowly for BPO-common reactions, also known to be cross-reactive within the penicillin group 10,48…”

Section: Discussionmentioning

confidence: 99%

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<p>Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins</p>

Jiménez-Rodriguez¹,

Blanca‐López²,

Ruano-Zaragoza³

et al. 2019

JAA

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PurposeElderly people thought to have an allergy to beta-lactams (BLs) may tolerate the drugs in subsequent exposures due to initial false labeling of allergies, the spontaneous loss of sensitivity to BLs over time or age-related decline in sensitization. As a result, they may be treated with less appropriate antibiotics, causing more side effects and entailing increased costs for health systems. The aim of this investigation was to assess whether patients in the third and fourth age with previously confirmed allergies to BLs had lost sensitization and could tolerate these antibiotics.Patients and methodsPatients allergic to BLs were divided into group A (aged 60–79 years) and B (aged ≥80 years). Clinical history, skin testing, drug challenge tests (DCT) and evaluation of resensitization were used to classify participants as showing immediate reactions, non-immediate reactions, or tolerance. We compared clinical entities, drugs involved, and final outcome by age group.ResultsOf 1362 cases evaluated, 565 underwent an allergological study. The skin was the most common organ involved. Anaphylaxis and side chain reactions were more frequent in group A (p<0.01), as were positive DCT. Classical benzylpenicillin determinants (benzylpenicilloyl and/or minor determinant mixture) were more frequent triggers in group B (p< 0.01). Resensitization after challenge occurred in very few participants.ConclusionThe risk for allergy to BLs decreases with age and a history of anaphylaxis by BLs is a predictor of positive results in skin tests (ST). Both immunoglobin E (IgE) and T-cell–mediated responses can disappear in elderly people, who can develop tolerance to these antibiotics. These results are of clinical relevance to patients who need to be treated with antibiotics from this family.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

<p>Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins</p>

Jiménez-Rodriguez¹,

Blanca‐López²,

Ruano-Zaragoza³

et al. 2019

JAA

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“…A well-established multiplex in vitro method was herein followed to evaluate the presence of IgE antibodies in a defined allergic population in which augmentin, CFR and AMX were the drugs that most often induced immediate reactions. As some authors suggest that anaphylaxis predominates the cutaneous condition 46 (presented as urticaria) in allergic reactions to BLCs, using a multiplex in vitro test is a good alternative to in vivo assays to detect positive patients in short times and to study a conjunction of BLCs together and instantaneously given this multiplex capacity. The problem with false-negatives is also noteworthy.…”

Section: Evaluation Of the Structural Determinants With Human Serum Smentioning

confidence: 99%

Neo-antigens for the serological diagnosis of IgE-mediated drug allergic reactions to antibiotics cephalosporin, carbapenem and monobactam

Peña-Mendizabal

Morais

Maquieira

2020

Sci Rep

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New antigens deriving from -lloyl and -llanyl, major and minor determinants, respectively, were produced for β-lactam antibiotics cefuroxime, cefotaxime, ceftriaxone, meropenem and aztreonam. Twenty β-lactam antigens were produced using human serum albumin and histone H1 as carrier proteins. Antigens were tested by multiplex in vitro immunoassays and evaluated based on the detection of specific IgG and IgE in the serum samples. Both major and minor determinants were appropriate antigens for detecting specific anti-β-lactam IgG in immunised rabbit sera. In a cohort of 37 allergic patients, we observed that only the minor determinants (-llanyl antigens) were suitable for determining specific anti-β-lactam IgE antibodies with high sensitivity (< 0.01 IU/mL; 24 ng/L) and specificity (100%). These findings reveal that not only the haptenisation of β-lactam antibiotics renders improved molecular recognition events when the 4-member β-lactam ring remains unmodified, but also may contribute to develop promising minor antigens suitable for detecting specific IgE-mediated allergic reactions. This will facilitate the development of sensitive and selective multiplexed in vitro tests for drug-allergy diagnoses to antibiotics cephalosporin, carbapenem and monobactam.

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“…N. Blanca-Lopez и соавт. обращают особое внимание на тот факт, что принципиальное значение для определения типа аллергической реакции имеют время возникновения симптомов и их характер [14]. Тщательный сбор анамнеза позволяет дифференцировать истинную аллергию (тип В нежелательных побочных реакций [НПР] -непредсказуемые иммунно-опосредованные реакции, не зависящие от дозы) и неаллергические НПР (тип Апредсказуемые дозозависимые неиммунные реакции).…”

Section: типы аллергических реакцийunclassified

“…В соответствии с классификацией P. Gell и R. Coombs, аллергия на пенициллины обусловлена реакциями I типа (IgE-опосредованными) и IV типа (табл. 1) [14,18,19].…”

Section: типы аллергических реакцийunclassified

Management of patients with a history of beta-lactam intolerance

Gomon¹,

Irkhina²,

Колбин³

et al. 2020

CPT

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Penicillins are one of the most commonly prescribed groups of antimicrobials. Up to 8-25% of the general population has a history of allergy to penicillins. However, hyperdiagnostics of penicillin allergy occurs in 90 to 95% of cases, mostly before the age of 3 years, and is associated with an incorrect interpretation of the symptoms of viral infections. The real frequency of life-threatening conditions associated with beta-lactam allergy does not exceed 0.04% of cases of penicillin administration. Hyperdiagnostics of beta-lactam allergy results in a decrease in the quality of medical care, as well as additional costs for the healthcare system. Careful anamnesis, identifying of patients with low risk of allergic reactions to penicillins and oral and skin tests allow to rule out or to establish allergy to beta-lactam antimicrobials and to choose the optimum antimicrobial therapy.

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Allergic reactions to penicillins and cephalosporins: diagnosis, assessment of cross-reactivity and management

Abstract: El artículo seleccionado no se encuentra disponible por ahora a texto completo por no haber sido facilitado todavía por el investigador a cargo del archivo del mismo.

Cited by 13 publications

References 118 publications

<p>Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins</p>

<p>Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins</p>

Neo-antigens for the serological diagnosis of IgE-mediated drug allergic reactions to antibiotics cephalosporin, carbapenem and monobactam

Management of patients with a history of beta-lactam intolerance

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