Role of minor determinants of amoxicillin in the diagnosis of immediate allergic reactions to amoxicillin

Torres, Marı́a José; Ariza, Adriana; Fernández, J.; Moreno, Esther; Laguna, José Julio; Montañez, María Isabel; Ruiz-Sánchez, Antonio J.; Blanca, Miguel

doi:10.1111/j.1398-9995.2009.02245.x

Cited by 58 publications

(38 citation statements)

References 19 publications

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“…The addition of minor determinants of amoxicillin does not, however, increase the detection rate [126]. The higher use of amoxicillin in Europe is a likely explanation for the different findings.…”

Section: Skin Test Reagentsmentioning

confidence: 69%

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: Skin Test Reagentsmentioning

confidence: 69%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

View full text Add to dashboard Cite

show abstract

“…4,5,7 With these reagents, however, the diagnostic sensitivity has been reported to be no higher than 70%, 8,9 and the addition of other amoxicillin determinants has not improved this sensitivity. 10 In case of immediate reactions to cephalosporins, it is crucial to also include the suspected compound in skin testing. In effect subjects with cephalosporin allergy may present positive responses to common penicillin determinants or respond selectively to cephalosporin determinants with a good tolerance of penicillins.…”

Section: Skin Prick and Intradermal Testsmentioning

confidence: 99%

Diagnosis and management of drug hypersensitivity reactions

Romano¹,

Torres

Castells

et al. 2011

Journal of Allergy and Clinical Immunology

170

117

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“…Moreover, inadvertent exposures may occur by contact with containers, occupational, seminal transmission and other indirect ways that may contribute to resensitization or clinical manifestations [31]. The inclusion of amoxicilloic acid and diketopiperazine in both skin testing and basophil activation tests in patients with immediate allergic reactions to amoxicillin do not seem to improve the diagnosis [32]. Further efforts are required to find new structures that can improve IgE recognition.…”

Section: Key Pointsmentioning

confidence: 97%