*Nonimmediate reactions to betalactams: prevalence and role of the different penicillins

Terrados, S.; Blanca, Miguel; Garcı́a, J.J.; Vega, José M.; Torres, Marı́a José; Carmona, Marı́a José; Miranda, A.; Moya, M.; Juárez, C.; Fernández, J.

doi:10.1111/j.1398-9995.1995.tb01200.x

Cited by 107 publications

(97 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In some cases of maculopapular exanthems, tested skin has been biopsied and found to present histological features similar to those of the original lesion with cell infiltrates like those in delayed hypersensitivity skin reactions of the tuberculin type (9,23,29,33,43), while in others, challenges with suspect b-lactams have confirmed à In addition, T-cell help in Ig-production/switch by some cytokines (e.g. IL-4, IL-5, IFN-c).…”

Section: Skin Testsmentioning

confidence: 89%

“…In delayed allergy to aminopenicillins, both the b-lactam core structure and the whole molecule (core structure and the amino-benzyl group of the side chain) are recognized by T cells (54,55). However, the amino-benzyl group plays a predominant role: more than 70% of patients with such hypersensitivity display negative responses to BP in intradermal and/or patch tests (32,33,37,42,46). This means that alterations of side chains affect recognition, but also that the same side chains presented by cephalosporin core structures are not recognized.…”

Section: Patch Testingmentioning

confidence: 99%

“…However, there were also patients who react to the provocation test with nonimmediate cutaneous eruptions, particularly maculopapular and urticarial (27,33,42,65). Specifically, in the study by Luque et al (65), which assessed 19 patients with nonimmediate reactions to b-lactams, 12 subjects displaying negative responses to intradermal tests reacted to the challenge.…”

Section: Provocation Testsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

Self Cite

318

363

View full text Add to dashboard Cite

Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during β‐lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug‐specific T‐cell clones obtained from the circulating blood and the skin, suggest that a type‐IV (cell‐mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work‐up, the patient's history is fundamental; patch testing is useful, together with delayed‐reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to β‐lactams.

show abstract

Section: Skin Testsmentioning

confidence: 89%

Section: Patch Testingmentioning

confidence: 99%

Section: Provocation Testsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Romano

Blanca

Torres

et al. 2004

Allergy

Self Cite

318

363

View full text Add to dashboard Cite

show abstract

“…According to the penicillin model, nonimmediate reactions can occur as soon as 1-2 hours after administration [62,63]. In fact, generalized urticarial reactions mimicking anaphylaxis have been reported with amoxicillin and were first thought to be IgE-like accelerated reactions; however, it was subsequently demonstrated that the mechanism is in fact T cell-dependent [64].…”

Section: Nonimmediate Reactionsmentioning

confidence: 99%

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Rosado¹,

Díaz²,

Moreno³

et al. 2016

J Investig Allergol Clin Immunol

112

122

View full text Add to dashboard Cite

The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported. Key words: Iodinated. Gadolinium. Contrast media. Allergy. Hypersensitivity. Anaphylaxis. Immediate reactions. Nonimmediate reactions. PrologueThe objective of these guidelines is to ensure efficient and effective clinical practice in the diagnosis and management of hypersensitivity reactions to radiologic contrast media. The guidelines were developed by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) with extensive clinical expertise in the evaluation and management of hypersensitivity reactions and broad research experience.We performed a systematic and independent review of the literature up to November 2015 and established a consensus of expert opinion. We evaluated the applicability of the guidelines in our daily clinical practice. The guidelines were evaluated and criticized by external reviewers with expertise in the field. MethodThe panel of experts who produced this consensus document developed a research protocol outlining the background to the subject of study, the objectives of the study, and the questions and hypotheses from which search criteria were defined.The main sources used for the literature search included electronic databases and archives (MEDLINE-PubMed, Science Direct, OVID) and a database of systematic re...

show abstract

“…Moreover, since 1966 there have been studies suggesting that the delayed reading of intradermal skin tests and/or patch tests can be an effective way of diagnosing nonimmediate allergic reactions to systemically administered β-lactams, such as maculopapular and urticarial rashes [1, 2, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. In some cases, challenges with suspect β-lactams have confirmed allergologic test positivity [2, 20, 23, 24, 25, 26, 29].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Romano

Viola

Mondino

et al. 2002

Int Arch Allergy Immunol

View full text Add to dashboard Cite

Background: Maculopapular and urticarial rashes are nonimmediate manifestations common during penicillin treatment; the former often represent cell-mediated hypersensitivity. Our objectives were to assess the incidence of allergy in adults reporting nonimmediate manifestations during penicillin therapy and to evaluate the diagnostic potential of patch tests, delayed-reading skin tests and challenges in such cases. Methods: We used prick and intradermal tests as well as patch tests with penicillin determinants, ampicillin, amoxicillin and any other suspect penicillins. We also performed challenges with the suspect antibiotics. Results: Such antibiotics were aminopenicillins in 93.1% of 259 patients, most of whom had suffered from maculopapular rashes followed by piperacillin (4.2%). Three subjects displayed immediate skin test positivity. Ninety-four subjects showed patch test and delayed intradermal test positivity to the culprit penicillin (90 to aminopenicillins and 4 to piperacillin) and were considered as having had delayed hypersensitivity reactions. Five of the 8 subjects who displayed delayed intradermal test positivity and patch test negativity to the suspect penicillin underwent challenges, 2 reacted positively to the responsible aminopenicillin. Among the remaining 154 with negative results in allergologic tests, 125 agreed to undergo challenges; only 3 reacted. In all, 98 patients – 93 of whom had experienced maculopapular rashes – displayed delayed hypersensitivity (94 to aminopenicillins and 4 to piperacillin). Conclusions: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to penicillins, particularly maculopapular rashes. Patch test and delayed intradermal positivity together indicate delayed hypersensitivity. Intradermal testing appears to be slightly more sensitive than patch testing.

show abstract

*Nonimmediate reactions to betalactams: prevalence and role of the different penicillins

Cited by 107 publications

References 24 publications

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Diagnosis of nonimmediate reactions to β‐lactam antibiotics

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media

Diagnosing Nonimmediate Reactions to Penicillins by in vivo Tests

Contact Info

Product

Resources

About