Changes in Sensitization Patterns in the Last 25 Years in 619 Patients with Confirmed Diagnoses of Immediate Hypersensitivity Reactions to Beta-Lactams

Abstract

Beta-lactam (BL) drugs are the antibiotics most prescribed worldwide due to their broad spectrum of action. They are also the most frequently implied in hypersensitivity reactions with a known specific immunological mechanism. Since the commercialization of benzylpenicillin, allergic reactions have been described; over the years, other new BL drugs provided alternative treatments to penicillin, and amoxicillin is now the most prescribed BL in Europe. Diagnosis of BL allergy is mainly based on skin tests and drug provocation tests, defining different sensitization patterns or phenotypes. In this study, we evaluated 619 patients with a confirmed diagnosis of BL-immediate allergy during the last 25 years, using the same diagnostic procedures with minor adaptations to the successive guidelines. The initial eliciting drug was benzylpenicillin, which changed to amoxicillin with or without clavulanic acid and cephalosporins in recent years. In skin tests, we found a decrease in sensitivity to major and minor penicillin determinants and an increase in sensitivity to amoxicillin and others; this might reflect that the changes in prescription could have influenced the sensitization patterns, thus increasing the incidence of specific reactions to side-chain selective reactions.

Differences in beta-lactam and penicillin allergy: Beyond the West and focusing on Asia-Pacific

“…In a 13-year United States study, the rate of positive penicillin skin tests dropped from more than 10% to below 5% ( 46 ). Another recent Spanish study also showed a progressive decrease in sensitization rate to penicillin determinants from 57.6% to 22.1% over the last 25 years, echoing past European findings that the diagnostic sensitivity of PPL, MDM and BP has dropped to only 20% and omission of these determinants in skin test was justified ( 47 – 49 ). Differences in sensitization patterns between Asia-Pacific and European countries have been directly compared.…”