Abstract
ABSTRACTBetalactams are the most frequent cause of hypersensitivity reactions to drugs mediated by a specific immune mechanism. Immediate reactions occur within 1 to 6 hours after betalactam administration, and are generally IgE-mediated. They clinically translate into urticaria, angioedema and anaphylaxis. Non-immediate or delayed reactions occur after 1 hour of administration. These are the most common reactions and are usually mediated by T cells. The most frequent type is the maculopapular or morbilliform exanthematous eruption. Most individuals who report allergies to penicillin and betalactams can tolerate this group of antibiotics. To make diagnosis, a detailed medical history is essential to verify whether it was an immediate or non-immediate reaction. Thereafter, in vivo and/or in vitro tests for investigation may be performed. The challenging test is considered the gold standard method for diagnosis of betalactam hypersensitivity. The first approach when suspecting a reaction to betalactam is to discontinue exposure to the drug, and the only specific treatment is desensitization, which has very precise indications. The misdiagnosis of penicillin allergy affects the health system, since the “penicillin allergy” label is associated with increased bacterial resistance, higher rate of therapeutic failure, prolonged hospitalizations, readmissions, and increased costs. Thus, it is essential to develop strategies to assist the prescription of antibiotics in patients identified with a label of “betalactam allergy” at hospitals, and to enhance education of patients and their caregivers, as well as of non-specialist physicians.
Highlights
Betalactam (BL) antibiotics are the first choice of treatment of several infections.(1) They include penicillins, cephalosporins, carbapenems, and monobactams.(2) Among their indications, the role of penicillin stands out in the prevention of rheumatic fever and treatment of syphilis, diseases that are still very prevalent in our country
In a short period of time, rapid drug desensitization (RDD) induces the lack of temporary response to a particular drug that had previously induced a hypersensitivity reaction, allowing the patient to be safely exposed to the culprit drug. This lack of temporary response may be obtained by the gradual reintroduction of small doses of the drug involved up to the total target dose, notably reducing the risk of severe and potentially lethal Drug hypersensitivity reactions (DHR).(51) Evidence suggests that anaphylaxis effector cells, mast cells, and basophils become transiently hyporresponsive.(54) Clinical tolerance has been described as occurring within a few hours in patients undergoing RDD - a time that does not allow the induction of tolerance at the level of T cells
The label “betalactam allergy” is a major public health problem, because it leads to the use of alternative antibiotics, which are less effective, more toxic, more expensive, and can contribute to increased bacterial resistance
Summary
Mara Morelo Rocha Felix[1], Marcelo Vivolo Aun[2], Ullissis Pádua de Menezes[3], Gladys Reis e Silva de Queiroz[4], Adriana Teixeira Rodrigues[5], Ana Carolina D’Onofrio-Silva[6], Maria Inês Perelló[7], Inês Cristina Camelo-Nunes[8], Maria Fernanda Malaman[9]. How to cite this article: Felix MM, Aun MV, Menezes UP, Queiroz GR, Rodrigues AT, D’Onofrio-Silva AC, et al Allergy to penicillin and betalactam antibiotics. Immediate reactions occur within 1 to 6 hours after betalactam administration, and are generally IgE-mediated. They clinically translate into urticaria, angioedema and anaphylaxis. Non-immediate or delayed reactions occur after 1 hour of administration These are the most common reactions and are usually mediated by T cells. Os beta-lactâmicos constituem a causa mais frequente de reações de hipersensibilidade a fármacos mediadas por mecanismo imunológico específico. As reações imediatas ocorrem em 1 até 6 horas após a administração do beta-lactâmico, sendo geralmente IgE-mediadas. Descritores: Beta-lactamas/efeitos adversos; Penicilinas/efeitos adversos; Antibacterianos/efeitos adversos; Hipersensibilidade a drogas/diagnóstico
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