Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams

Antúnez, C.; Martin, E.; Cornejo-García, J.A.; Blanca‐López, Natalia; R-Pena, R.; Mayorga, Cristobalina; Torres, Marı́a José; Blanca, M.

doi:10.2174/138161206778194042

Cited by 56 publications

(39 citation statements)

References 60 publications

(107 reference statements)

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“…In recent years, a number of studies have supported this finding [2][3][4][5]. In contrast to reactions to ß-lactams (BLs), which are immunologically mediated [6], DHRs to NSAIDs may be induced by both specific immunological mechanisms (allergic or selective reactions [SRs]) and mechanisms not based on immunological recognition (cross-hypersensitivity reactions [CRs]) [7]. Although the latter are responsible for the largest number of affected patients in some countries [1,8], SRs account for a considerable proportion in others [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…There is some evidence indicating that individuals may react to several NSAIDs but tolerate ASA [10,26]. Contrary to BL reactions, where all drugs share a common ring that may influence the specificity of the response and cross-reactivity [6,18], NSAIDs comprise a heterogeneous family of chemical structures with a variable degree of cross-reactivity within each group [9,11]. In this manuscript, we present findings for a series of patients who developed immediate SRs to 2 or more NSAIDs, verify tolerance to ASA, and assess the involvement of the culprit drug(s) using challenge testing.…”

Section: Introductionmentioning

confidence: 99%

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Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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Background: Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. Methods: Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. Results: From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. Conclusions: Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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“…Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicines involved in drug hypersensitivity reactions in both adults [2] and children [3] followed by β-lactam antibiotics [4]. Hypersensitivity reactions to NSAIDs have been classified into different categories depending on the clinical symptoms induced, the number of NSAIDs involved and the presence or absence of underlying disease [5].…”

Section: Introductionmentioning

confidence: 99%

Allergic Reactions to Metamizole: Immediate and Delayed Responses

Blanca‐López

Pérez‐Sánchez²,

Agúndez³

et al. 2016

Int Arch Allergy Immunol

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Background: Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Methods: Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. Results: A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. Conclusions: SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites.

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“…Hypersensitivity reactions to β-lactam antibiotics are among the most common drug reactions [1,2,3]. Since their introduction to the market, penicillin skin tests with major (benzylpenicilloyl-polylysine, PPL) and minor determinants (minor determinant mixture, MDM) of penicillin have had a major impact on the diagnosis of immediate hypersensitivity to β-lactams [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Since their introduction to the market, penicillin skin tests with major (benzylpenicilloyl-polylysine, PPL) and minor determinants (minor determinant mixture, MDM) of penicillin have had a major impact on the diagnosis of immediate hypersensitivity to β-lactams [1,2]. Application of these tests in clinical practice has revealed that the majority of patients with a history of immediate reactions to β-lactams were not really allergic to penicillin [4,5].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Çelik¹,

Aydın²,

Doğu³

et al. 2011

Int Arch Allergy Immunol

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Background: Diagnosing immediate hypersensitivity to β-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to β-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. Methods: Eighty patients (age range: 6–74 years) with a history of immediate reactions to β-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use β-lactam antibiotics in future whenever their use was indicated. Results: Overall, 29 patients (36.2%) were diagnosed as β-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. Conclusions: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to β-lactams. If these steps are negative, the patients usually tolerate β-lactams and only a few develop mild, non-life-threatening reactions in the long term.

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Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams

Cited by 56 publications

References 60 publications

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Allergic Reactions to Metamizole: Immediate and Delayed Responses

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

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