Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

Abstract

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics 121 guidelines Abstract This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach-even in cases where the need to administer a BLA is acute-is guided by patient history and risk-benefit ratio in the individual case.

Cefazolin-induced hemolytic anemia: a case report and systematic review of literature

“…We are suggesting that in our case, prior penicillin allergy might have played a role. The cross-reactivity between penicillins and cephalosporins can be attributed to similarities in their side chains [ 10 ]. Aminopenicillins (ampicillin) and aminocephalosporins (first generation—cefaclor, cefalexin, and cefadroxil) share an NH2 group at the R1 position and are susceptible to cross-reactivity [ 10 ].…”

“…The cross-reactivity between penicillins and cephalosporins can be attributed to similarities in their side chains [ 10 ]. Aminopenicillins (ampicillin) and aminocephalosporins (first generation—cefaclor, cefalexin, and cefadroxil) share an NH2 group at the R1 position and are susceptible to cross-reactivity [ 10 ]. Cefazolin (also a first-generation cephalosporin) does not have an NH2 group, making it less likely, but not impossible, for it to have cross-reactivity [ 11 , 12 ].…”

Isolierte Zungenschwellung nach Penicillin und negative Allergieabklärung – alles in Butter?

“…Die allergologische Abklärung erfolgte analog der einschlägigen Guidelines 3 8 9 . Neben einer Abklärung des wahrscheinlichen Red-Man-Syndroms war das Ziel, die Verdachtsdiagnose einer Penicillinallergie zu erhärten oder ein „De-Labeling“ zu erreichen.…”

“…Basophilenaktivierungstests 3 8 9 . Die publizierte Sensitivität und Spezifität der diagnostischen Mittel ist allerdings eingeschränkt und variiert deutlich in Abhängigkeit vom untersuchten Kollektiv und der Vortest-Wahrscheinlichkeit 12 , der Latenz zwischen klinischer Reaktion und Abklärung 13 und Schweregrad der initialen Reaktion 8 12 .…”

Allergische Reaktionen auf COVID-19-Impfungen – Was HNO-Ärzte wissen sollten – Teil 1: Immunologische Grundlagen von Allergien auf Impfstoffe, Immunmechanismen von allergischen und pseudoallergischen Reaktionen; Teil 2: Charakteristika der mRNA-Impfstoffe BNT162b2- und mRNA-1273 zur Prophylaxe von COVID-19 und assoziierte Immunphänomene; Teil 3: Praktische Aspekte der Prophylaxe, Diagnostik und Therapie von Allergien auf COVID-19-Impfstoffe

“…Die Häufigkeit anaphylaktischer Reaktionen hat in den letzten Jahren deutlich zugenommen [5,6]. Auch andere allergische Reaktionen auf Medikamente und Impfstoffe wurden beschrieben, insbesondere wurde über schwere Anaphylaxien auf Nahrungsmittel und Medikamente berichtet [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”