Side‐chain‐specific reactions to betalactams: 14 years later

Drug-Induced Anaphylaxis

“…Out of all drug reactions attended to an emergency department, anaphylaxis to NSAIDs has been shown to be the most common entity [24•]; however, the most severe reactions are likely to be induced by BLs. Of these, amoxicillin is the most frequent culprit in many countries [25,26], although clavulanic acid is becoming more prevalent in the induction of immediate hypersensitivity BL reactions including anaphylaxis [27,28].…”

“…anaphylaxis, a skin test is performed with penicillin determinants as recommended. The concept of major/minor determinants of benzyl penicillin (PPL and MDM) has now been surpassed since these drugs are not the most frequent elicitors of anaphylaxis [26], and it is now recommended to include amoxicillin determinants, and if the culprit drug is a cephalosporin, this must also be included. In those countries where clavulanic acid is becoming an important elicitor, the inclusion of this drug is also recommended (clavulanic for skin prick test) [27,28].…”

“…Although they are generally less sensitive than skin testing [26], there are instances in which the in vitro test can be positive in the absence of an in vivo positive response [44]. Experimental prototypes have been developed for some drugs, such as pyrazolones and ASA; however, they are not yet available in routine clinical practice [80,82].…”

“…In DIA the initial concentration should be very low and increased at intervals of 30 min [26]. This approach is different for crossintolerant NSAID-induced DIA.…”

“…through skin prick or intradermal testing). For BLs, it is recommended, according to severity, to begin with doses of less than one thousandth of the initial concentration and in some cases not testing all determinants simultaneously [19,26,45]. The use of this measure has led to an important reduction in the number of reactions induced in such units [26].…”