Antibiotic Allergy: A Clinical Review

Abstract

Introduction: Antibiotics are commonly associated with hypersensitivity reactions. These can be expressed through clinical manifestations that range from mild symptoms to severe life-threating reactions. Nevertheless, these are often mistaken with adverse events. Incorrect labeling off a patient as allergic, leads to increase in costs and morbidity in the health care setting. Objectives: Review currently available information on evaluation, diagnosis and treatment of allergic antibiotic reactions. Methods: A search was conducted in the PubMed, filtering results to articles published in the last ten years, in English, in adults and with full texts available. Out of the eight hundred and twenty-six results, seventy-three were selected. Results: Diagnosis of allergic events requires a detailed anamnesis. Confirmation of the diagnosis is influenced by the clinical features and the type of reaction, immediate or nonimmediate. The first can be evaluated with skin tests and drug provocation tests. The latter are studied with delayed-reading skin tests and drug provocation tests. Management of these patients should follow avoidance and application of an alternative tolerated drug. However, if the drug in question is indispensable for the treatment of the patient, then desensitization can be tried. Discussion: Clinical history is a fundamental component in the management of these patients. Skin tests are less well validated to antibiotics other than β-lactam. In vitro tests have not been fully validated in large samples of subjects. Desensitization has been validated for patients with β-lactam immediate reactions, but further investigation is required for non-immediate reactions, as well as, for non β-lactam antimicrobials. Conclusion: Management of antimicrobial hypersensitivity follows specific considerations in function of the type of allergic reaction and antibiotic class. Further investigation regarding immunochemistry and validation of diagnostic tests for non β-lactam antibiotics is required.

Aminoglycoside Allergic Reactions

“…Cross-reactivity between the deoxystreptamine-containing aminoglycosides and streptidine-containing streptomycin has not been observed. Streptidine in streptomycin is responsible for its antigenicity; therefore, deoxystreptamine-sensitive individuals are less likely to develop allergic cross-reactions to streptomycin therapy [14].…”