Hypersensitivity to piperacillin

Cabañas, Rosario; Muñoz, Luis Sánchez; López-Serrano, Concepción; Contreras, J; Padial, A.; Caballero, T.; Moreno-Ancillo, A; Paredes, Pilar

doi:10.1111/j.1398-9995.1998.tb03986.x

Cited by 11 publications

(6 citation statements)

References 5 publications

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“…In contrast, aromatic anticonvulsant drugs and allopurinol are the most frequently reported drugs associated with DRESS syndrome 3 . Although there are previous cases of AGEP or DRESS syndrome caused by piperacillin/tazobactam 8 9 10 , the coexistence of AGEP and DRESS in the same patient is quite rare, and to the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam. Although AGEP is a self-limiting condition with a good prognosis, close monitoring is needed depending on the causative drug and the patient's immune status, as in the case of this patient.…”

Section: Discussionmentioning

confidence: 85%

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

et al. 2016

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Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.

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Section: Discussionmentioning

confidence: 85%

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

et al. 2016

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“…Our patient displayed positive responses to both in vivo and in vitro tests with piperacillin and mezlocillin. She also presented negative responses to in vitro tests with the other β‐lactams assessed, and, like the patients of the above‐mentioned studies (2, 3), negative responses to delayed‐reading intradermal tests and patch tests with β‐lactams, other than piperacillin and mezlocillin. However, unlike these patients, our subject underwent challenges with negative β‐lactams and tolerated them.…”

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confidence: 90%

“…Like mezlocillin, piperacillin is a wide‐spectrum acylureidopenicillin, which can provoke all kinds of nonimmediate reactions, particularly maculopapular rashes (1). In some of the latter, a cell‐mediated pathogenic mechanism has been diagnosed on the basis of patch‐test and/or delayed‐reading intradermal test positivity (2–5). In particular, Warrington et al.…”

mentioning

confidence: 99%

“…(2) and Cabañas et al. (3) described two different patients who had experienced maculopapular eruptions associated with piperacillin treatments, one of whom presented delayed‐reading intradermal test positivity to piperacillin and the other patch‐test positivity to the same drug. Both of them displayed allergologic‐test negativity to the classic penicillin determinants, as well as to ampicillin and amoxicillin.…”

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confidence: 99%

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Delayed hypersensitivity to acylureidopenicillins: a case report

Gaeta¹,

Alonzi²,

Valluzzi³

et al. 2008

Allergy

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“…A recent study of 48 Italian subjects with IgE-mediated allergic reactions to ampicillin found that only three (6.25 %) cases were selective reactors [35]. IgE allergic selective reactions to penicillin V [36][37][38], cloxacillin [39,40], and piperacillin [41,42] have also been reported for a limited number of cases. In T-cell-mediated reactions, it is worth mentioning that selective reactions to piperacillin have been described in patients with cystic fibrosis [43,44] and as an occupational allergy [45].…”

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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Hypersensitivity to piperacillin

Cited by 11 publications

References 5 publications

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

Delayed hypersensitivity to acylureidopenicillins: a case report

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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