Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

Abstract

Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as beta-lactam allergic do not have clinically significant allergies that may hinder the use beta-lactam therapy when indicated. Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse effects, and use of broader spectrum antibiotics than indicated, which may contribute to antimicrobial resistance. The purpose of this review is to provide an overview of beta-lactam allergy and highlight the role of pharmacists in managing beta-lactam allergies. Studies have shown that pharmacists can play a vital role in allergy assessment, penicillin skin testing, beta-lactam desensitization, evaluation of beta-lactam cross-reactivity and recommending appropriate antibiotic therapy in patients with beta-lactam allergies.

Management and Implications of Beta-Lactam Allergies

“…Allergies to beta-lactams originate from an adaptive immune system response that triggers hypersensitivity reactions. Additionally, hypersensitivity reactions to penicillin may occur without recognized previous exposure and might be because of environmental exposure from animal-origin food such as milk or fungus-producing penicillin [ 10 , 11 ]. Furthermore, hypersensitivity reactions are classified into four types, which are described in the following table (Table 2 ).…”

“…This leads to increased vascular permeability and generalized smooth muscle contraction, potentially resulting in anaphylactic shock. These reactions are immediate and may present with symptoms such as urticaria, redness, breathing difficulties, bronchospasm, swelling, hypotension, tachycardia, altered mental state, or gastrointestinal discomfort [ 10 ].…”

“…Besides the structure of the central ring, beta-lactam antibiotics have different side chains that can also cause type I allergic reactions. These reactions are individualized and vary in severity [ 10 , 12 ].…”

“…The non-immediate or late reactions occur after six hours of drug administration and are mediated by antigenspecific T cells. The clinical presentation ranges from benign rashes to potentially life-threatening severe cutaneous adverse reactions [8][9][10].…”

Diseño, obtención y caracterización de proteínas recombinantes a partir de determinantes antigénicos asociadas a reacciones alérgicas a ß-lactámicos.

“…30,31 Sin embargo, solo un 10% de los pacientes presentan verdadera alergia. 32 Entre esta familia de antibióticos, la penicilina es la causante de alergia farmacológica más común identificada en los registros médicos, con una prevalencia que oscila entre el 6 y el 25% según la población de tratamiento. 33,34 La aparición de síntomas se asocia a reacciones de hipersensibilidad probablemente relacionadas con el fármaco 35 , pero también con interacciones farmacológicas relacionadas con otras infecciones, como cuando un paciente desarrolla una erupción maculopapular a causa de una infección por el virus de Epstein-Barr tras haber sido medicado con una aminopenicilina.…”