Epitope Analysis of Aztreonam by Antiaztreonam Monoclonal Antibodies and Possible Consequences in Beta-Lactams Hypersensitivity

Shimizu, Tohru; Souma, Shinji; Nagakura, Naotaka; Masuzawa, Toshiyuki; Iwamoto, Yoshihisa; Yanagihara, Yukiyoshi

doi:10.1159/000236216

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Carbapenems are able to induce the formation of specific IgG antibodies in animal models and specific IgE in exposed subjects, leading to allergic reactions [11]. Furthermore, aztreonam has been proven to be immunogenic, inducing IgG antibodies [12], and studies using monoclonal antibodies [20] revealed the importance of the side chain as they could recognize aztreonam and ceftazidime. Considering CLV, initial studies indicated a very low immunogenicity [11], although in the last decade, selective IgE-mediated reactions to this compound have been reported by BAT [21, 22••].…”

Section: Bl Immunological Recognitionmentioning

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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Section: Bl Immunological Recognitionmentioning

confidence: 99%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

View full text Add to dashboard Cite

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“…These have been recognized by IgG antibodies [58,59]. Three cell lines of hybridoma have been established to AZT [60]. Two of these lines recognize AZT and ceftazidime, indicating that the same acyl side chain is a relevant part of the epitope.…”

Section: Aztreonam (Azt) Is a Monocyclic Bl Isolated Frommentioning

confidence: 99%

Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams

Antúnez¹,

Martin²,

Cornejo-García³

et al. 2006

CPD

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Immediate hypersensitivity reactions to betalactams are IgE mediated and constitute the most frequent allergic reactions mediated by specific immunological mechanisms. IgE responses to benzyl penicillin (BP), the first antibiotic producing the benzyl penicilloyl structure (BPO), are characterized by a quick release of inflammatory mediators, resulting in anaphylactic shock, urticaria and angioedema. With the progressive appearance of other structures, comprising cephalosporins, carbapenems, monobactams and clavulanic acid, IgE selective responses and cross-reactivity reactions were observed. The diagnosis of betalactam hypersensitivity, classically based on skin testing with major and minor determinants of benzyl penicillin or in vitro IgE antibodies to BP, has been modified by the inclusion of different determinants generated from these compounds, for which amoxicillin (AX) is the most relevant, followed by cephalosporins. Some subjects develop positive responses to several betalactams, mostly within the same family, but others develop a selective response. These are relevant for the appropriate selection of antimicrobial drugs in patients who have immediate hypersensitivity to betalactams.

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“…Así, se han identificado tres epítopos diferentes, la cadena lateral, el núcleo del antibiótico, y la estructura completa. 58 No obstante, al tratarse de fármacos poco utilizados en el tratamiento de infecciones bacterianas, hay pocos estudios sobre la generación de otros determinantes antigénicos tras su degradación y metabolismo.…”

Section: • Cefalosporinasunclassified

Metodologías bioanalíticas para el diagnóstico in vitro de alergia a antibióticos ß-lactámicos

Rodriguez¹

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reconeixement. En aquesta línia de treball, l'ús d'altres estratègies de conjugació d'haptens ha suposat la millora de la sensibilitat clínica de l'assaig, identificant nous epítops. Aquest estudi va permetre classificar els pacients en quatre tipus en funció del patró de reconeixement, cosa que podria ser molt útil a l'hora d'establir tractaments clínics alternatius.En resum, les investigacions realitzades han permès desenvolupar nous formats d'assaig i coneixements immunoquímics, i han aportat noves i millors eines de diagnòstic clínic in vitro que permeten la determinació simultània d'IgE específica d'un ampli espectre d'antibiòtics β-lactàmics en sèrum humà, per baix dels nivells aconseguits pels mètodes in vitro de referència. Aquesta informació s'ha fet servir per al desenvolupament final d'un assaig multianalit i multimostra d'un sistema semi automatitzat.

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Epitope Analysis of Aztreonam by Antiaztreonam Monoclonal Antibodies and Possible Consequences in Beta-Lactams Hypersensitivity

Cited by 4 publications

References 9 publications

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams

Metodologías bioanalíticas para el diagnóstico in vitro de alergia a antibióticos ß-lactámicos

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