Anaphylaxis to amoxycillin but good tolerance for benzyl penicillin

Blanca, Miguel; Pérez, E.; Garcı́a, J.J.; Miranda, A.; Fernández, J.; Vega, José M.; Terrados, S.; Ávila, María José; Martin, Angela; Suau, Rafael

doi:10.1111/j.1398-9995.1988.tb01628.x

Cited by 105 publications

(45 citation statements)

References 7 publications

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“…Blanca et al [15,16] have described cases of hypersensitivity specifically to amoxicillin with positive skin test and radioallergosorbent test results to amoxicillin and with negative skin test results to the major and minor determinants of penicillin. These results suggest that the acyl side chain may be a significant antigenic determinant apart from the penicillin nucleus [15,16,18]. Vega et al [19] described a group of patients with suspected beta-lactam allergy who demonstrated allergic reactions only to amoxicillin (30.5%), while tolerating penicillin.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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Background: Allergy to penicillins remains an important issue. Penicillin skin testing (PST) with major and minor determinants has been shown to be a highly valuable tool for identifying IgE-mediated penicillin allergy. The value of additional testing with side-chain-specific moieties from semisynthetic penicillins such as amoxicillin is not well-established in spite of the widespread use of these medications. Methods: A retrospective review of all consecutive inpatient PST results from 1995 to 2007 comprising 1,068 patients was performed in our institution on individuals with a self-reported history of beta-lactam allergy to assess the importance of including the amoxicillin determinant in a previously validated PST panel. Descriptive statistics were performed. The PST panel included penicilloyl-polylysine, penicillin G, penicilloate, penilloate and amoxicillin. Results: Of 1,068 patients, 243 (23%) had a positive skin test reaction on the PST panel. Testing with amoxicillin was positive in 30.9% of patients, the majority of whom (81%) were also positive to 1 or more standard penicillin reagents. Fourteen of the 243 positive patients (5.8%) had a positive skin test reaction only to amoxicillin. Additionally, the use of penicilloate and penilloate minor determinants in combination with penicillin G identified a greater percentage of penicillin-allergic individuals compared to using only penicillin G (22.6 vs. 6.6%), demonstrating their importance in the PST panel. Conclusions: These data indicate that the inclusion of the amoxicillin determinant appears to identify a small but important group of allergic individuals who may otherwise test negative on a PST panel.

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Section: Introductionmentioning

confidence: 99%

“…Given the widespread use of semisynthetic penicillins, there may be a significant number of individuals who react only to the side-chain-related haptens [15,16,17]. A number of studies on amoxicillin allergy have been performed in Europe.…”

Section: Introductionmentioning

confidence: 99%

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Lin¹,

Saxon²,

Riedl³

2010

Int Arch Allergy Immunol

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“…[418][419][420][421]454 . The risk is highest with first generation cephalosporins and cephalosporins that have similar R-group side chains to specific penicillins 455,456 . The risk of penicillin cross-reactivity between most second-generation (cefoxitin) and all third generation cephalosporins (cefixime, ceftriaxone) is negligible [418][419][420][421] .…”

Section: Management Of Persons Who Have a History Of Penicillin Allergymentioning

confidence: 99%

1989 Sexually Transmitted Diseases Treatment Guidelines

&NA;

1990

The Pediatric Infectious Disease Journal

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This information is distributed solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy. Guidelines, 2010 (MMWR 201059 [No. RR-12] Contents IntroductionThe term sexually transmitted diseases (STDs)is used to refer to a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity. Physicians and other health-care providers play a critical role in preventing and treating STDs. These guidelines for the treatment of STDs are intended to assist with that effort. Although these guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed.This document updates the CDC Sexually Transmitted Diseases Treatment Guidelines published in 2010 1 .These recommendations should be regarded as a source of clinical guidance and not prescriptive standards. Health-care providers should always consider the clinical circumstances of each person in the context of local disease prevalence. These guidelines are applicable to any patient-care setting that serves individuals at risk for STDs, including familyplanning clinics, HIV-care clinics, private physicians' offices, Federally Qualified Health Centers, and other primary-care facilities. These guidelines focus on the treatment and counseling of individuals and do not address other community services and interventions that are essential to STD/human immunodeficiency virus (HIV) prevention efforts. MethodsThese guidelines were developed by CDC staff and an independent workgroup selected on the basis of their expertise in the field of STDs. Members of the multidisciplinary workgroup included representation from federal, state, and local health departments, clinical and basic science researchers, and numerous professional organizations. (listed at the end of this document). All workgroup members provided conflict of interest form and several members of the workgroup acknowledged receiving financial support from companies performing clinical research All potential conflicts of interest were disclosed and managed in accordance with the editorial standards of the journals that published the scientific reports.Specifically in 2012, CDC staff and workgroup members were asked to identify key questions regarding STD treatment and clinical management that emerged since the 2010 STD Treatment Guidelines.Development of these key questions focused on four principal outcomes of STD therapy for each individual disease or infection: 1) treatment of infection based on microbiologic eradication; 2) alleviation of signs and symptoms; 3) prevention of sequelae; and 4) prevention of transmission, 5) cost-effectiveness and other advantages and disadvantages of specific regimens. Then, CDC staff members assigned workgroup members key questions to research, and with the ...

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“…In 1990, Blanca et al [27,28] described a group of patients who developed severe anaphylactic reactions to AX but had good tolerance to BP. In vitro studies confirmed that these patients had IgE antibodies that preferentially recognized the AX side chain structure [29].…”

Section: Penicillin As An Alternative Treatmentmentioning

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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Anaphylaxis to amoxycillin but good tolerance for benzyl penicillin

Cited by 105 publications

References 7 publications

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

Penicillin Allergy: Value of Including Amoxicillin as a Determinant in Penicillin Skin Testing

1989 Sexually Transmitted Diseases Treatment Guidelines

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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