Management of Patients with a History of Allergy to Beta-Lactam Antibiotics

Yates, Anne B.

doi:10.1016/j.amjmed.2007.12.005

Cited by 70 publications

(57 citation statements)

References 10 publications

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“…There have been no large comparative studies between oral and IV routes of desensitization although both have been successfully utilized [215][216][217]. Continuous monitoring for adverse reactions is necessary for both routes.…”

Section: Desensitizationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Desensitizationmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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“…Tais reações englobam todos os tipos de reações adversas causadas pela resposta imunológica do paciente a essas drogas, destacando-se a hipersensibilidade imediata, caracterizada pelas respostas denominadas "imediatas e aceleradas", associadas à produção de imunoglobulinas, principalmente da classe IgE 3,4 , e hipersensibilidade tardia, onde a resposta aos antígenos envolve a resposta imune celular 1,5 . O tempo decorrido do contato com o antígeno até o desencadeamento da reação de hipersensibilidade não deve ser o único critério para a identificação do tipo de fenômeno envolvido.…”

Section: Introductionunclassified

Hipersensibilidade aos β-lactâmicos e outros antibióticos. Bases biológicas

Gandolfo¹,

Monteiro²,

Januzzi³

et al. 2016

Arch Health Invest

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3 ResumoEste estudo teve como objetivo avaliar a ocorrência de alergias aos antibióticos e antimicrobianos comumente utilizados em medicina e odontologia, discutindo os mecanismos envolvidos nas reações de hipersensibilidade. Pela literatura verificou-se que a maioria das alergias foi associada com o uso frequente de tais compostos e depende de medicamentos haptenização. A hipersensibilidade pode ser classificada em reacções immediadas e aceleradas, associadas com respostas humorais, ou mediadas por linfócitos T que reconhecem o antigénio apresentado por células apresentadoras de antigenos e liberam citocinas, resultando no recrutamento de diferentes tipos celulare, desencadeando a inflamação do tecido. Além disso, as declarações de 386 pacientes odontológicos foram analisadas e ocorrência de alergias aos antibióticos foram relatadas por 6,2% dos pacientes. As reacções às penicilinas foram predominantes (4,7%), seguidas da sulfanilamida (1,0%) e das cefalosporinas (0,5%). A sintomatologia predominante foi essencialmente cutânea. Também foram analisadas as consequências, diagnóstico e prevenção das alergias aos antimicrobianos. Este estudo concluiu que os β-lactâmicos foram as drogas mais alergênicas e a grande maioria das reações imunes foram desencadeadas contra eles. O tratamento de dessensibilização deve ser considerado a última abordagem clínica devido aos seus riscos para os pacientes. Descritores: Hipersensibilidade a Drogas; Antibacterianos; Alergia e Imunologia. AbstractThis study aimed to evaluate the occurrence of allergies to antibiotics and antimicrobials commonly used in medicine and dentistry, discussing the mechanisms involved in hypersensitivity reactions. In literature, it was verified that most allergies were associated with incremental use of such chemical compounds and depended on the drugs haptenation. Hypersensitivity can be classified into ready mediated and accelerated reactions, associated with humoral responses, or mediated by T lymphocytes that recognize antigen displayed by antigen-presenting cells and release cytokines, resulting in recruitment of several cell types and also trigger a tissue inflammation. In addition, declarations of 386 dental patients were analyzed and allergies were reported by 6.2% of patients. Reactions to penicillins predominated (4.7%), followed by sulfanilamide (1.0%) and cephalosporins (0.5%). Predominant symptomatology was essentially cutaneous. The consequences, diagnosis and prevention of drug allergy were also discussed. This study concluded that β-lactams were the most allergenic drugs and the vast majority of immune reactions were triggered against them. Desensitizing treatment must be considered the last clinical approach due to its risks for patients. Descriptors: Drug Hypersensitivity; Anti-Bacterial Agents; Allergy And Immunology. ResumenEste estudio tuvo como objetivo evaluar la aparición de alergias a los antibióticos y antimicrobianos de uso común en la medicina y la odontología, y discutir los mecanismos implicados en las reacciones de hipersen...

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“…Skin prick testing detects the presence of drug specific IgE in the skin and can therefore predict only the likelihood of IgE mediated drug allergy [25]. It is not useful for identifying other types of reactions.…”

Section: In Vivo Testing Skin Testingmentioning

confidence: 99%

Antibiotic Allergy, When to Test, Challenge or Desensitise

Nasr¹,

Wahshi²,

Wahshi³

et al. 2016

J Med Microb Diagn

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Antibiotics are widely used for treatment of bacterial infections and for prophylaxis during instrumental procedures and in certain conditions such as immunodeficiency and splenectomy.Hypersensitivity (allergic) reactions are unpredictable and can occur in some patients even if they have taken the antibiotic in the past with no reaction. Drug allergy accounts for 11.3% of all adverse drug reactions. Drug allergy drugs can be generally classified (according to the World Allergy Organization) based on timing of symptoms into immediate (Immunoglobulin E (IgE) mediated) occurring within 1 hour and delayed (non IgE mediated) allergic reactions occurring after 1 hour. Many patients are mislabeled with drug allergy especially when the diagnosis is made based on history alone. In such cases, a referral to an allergist is important to confirm or exclude allergy through a detailed clinical history, in vitro and/or in vivo testing, as over diagnosis of drug allergy leads to the unnecessary use of broader spectrum and expensive antibiotics contributing to the emergence of multidrug resistant pathogens. Also, in cases of confirmed drug allergy it is important to establish potential cross reactivity with other drugs. Equally, patients with confirmed drug allergy, who have an absolute requirement for the drug or cross reactive drug (as in penicillin allergic females with syphilis) can undergo a process of desensitization in order to complete their treatment through induction of temporary tolerance of the drug.

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Management of Patients with a History of Allergy to Beta-Lactam Antibiotics

Cited by 70 publications

References 10 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Hipersensibilidade aos β-lactâmicos e outros antibióticos. Bases biológicas

Antibiotic Allergy, When to Test, Challenge or Desensitise

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