Antibiotic Hypersensitivity in Patients with CF

Abstract

Antibiotic hypersensitivity reactions are relatively common in patients with cystic fibrosis (CF). The nature of the reactions and the mechanisms are no different in CF than the general population. Beta-lactam agents are the most common cause of these reactions. The risk depends on the specific beta-lactam agent used with Penicillins having a higher frequency of allergic reactions. There are several risk factors for developing these allergic responses, especially the increased usage. Since the available choices for antibiotic therapy is limited by the sensitivity of the organisms, management becomes a challenge. It is essential to classify the nature of the hypersensitivity reactions and determine the risks of repeat administration of the drug. Unfortunately, reliable skin tests are not available for all the antibiotics. RAST is of limited value. Recent data on cross-reactions between beta-lactam antibiotics and the option of newer agents offer useful alternative choices. Knowledge of the chemical structures of the antibiotics is useful for selecting suitable substitutes. Desensitization is a viable option in many of the reactions unless otherwise contradicted.

Cutaneous Manifestations of Cystic Fibrosis

“…Reactions include urticaria, angioedema, morbilliform rash, Stevens‐Johnson syndrome, and leukocytoclastic vasculitis. Mechanisms of hypersensitivity reaction are similar to that observed in the general population (52).…”

“…Drug hypersensitivity reactions occur in approximately 30% of CF patients (50,51). Increased antibiotic usage in response to chronic rates of infection, higher rates of atopy, and elevated circulating immune complexes have all been implicated as possible explanations for the high frequency of drug hypersensitivity reactions in CF patients (52). Reactions include urticaria, angioedema, morbilliform rash, Stevens‐Johnson syndrome, and leukocytoclastic vasculitis.…”

“…Delayed allergic reactions, including morbilliform rash and vasculitis, among others such as drug‐induced fever, are found to occur with a relatively high frequency in CF (52). In one study, 76% of CF patients developed “generalized rash” after treatment with piperacillin or azlocillin (53).…”

Piperacillin-induced mild haemolytic anaemia in a 44-year-old patient with cystic fibrosis

“…Reports of DIHA attributed to piperacillin are increasing, especially in patients with CF 4–12 16. Whether this unequal distribution is due to the frequent usage of piperacillin for pulmonary exacerbation in patients with CF or due to CF-related promoting cofactors, such as hyperinflammation, still need to be clarified 7 13 14 16…”

“…In general, in patients with CF the prevalence of adverse reactions to antibiotics is high 13. This hypersensitivity is of yet unclear aetiology and of variably reported prevalence,14 possibly due to unequal study cohorts. Whether patients with CF have a specific vulnerability for PIHA remains unclear.…”