Antibiotic allergies: targeted approach in suspected β‑lactam allergy

Abstract

Allergic reactions to antibiotics belong to hypersensitivity drug reactions and can trigger both immunoglobulinE-mediated symptoms and Tcell-mediated symptoms. Skin manifestations are the most common symptoms. Although reporting apenicillin allergy results in considerable restrictions in the treatment of acute infections, which may be associated with poor treatment outcomes, in most cases the label 'penicillin allergy' is not called into question or critically reviewed. However, in 85-90% of patients, 'penicillin allergy' constitutes amislabeling of anon-specific intolerance reaction that does not pose arisk to the patient when re-exposed to penicillins. Careful history taking, an evaluation of manifestations in the past, and easy-to-perform initial diagnostic steps are crucial in differentiating non-specific intolerance reactions from penicillin allergy sensu stricto. Thus, apenicillin de-labeling strategy allows for optimized antibiotic therapy in the event of afuture infection. Although allergic cross-reactivity between different β‑lactam antibiotics can occur, the risk for asevere cross-reactivity is dependent on chemical properties of the specific β‑lactam. Published cross-reactivity tables can help in risk stratification and choice of alternative β‑lactam agents.