Aztreonam Cell Mediated Hypersensitivity Cross Reactivity with Beta Lactam Antibiotics: The Possibility That It Exists

Ryan Urbas,Raxitkumar Patel,Arka Banerjee

doi:10.4236/crcm.2014.33033

Abstract

A 61-year-old female with past medical history of maculopapular rash reaction to ciprofloxacin and amoxicillin being treated for diverticulitis develops the same rash with administration of piperacillin/tazobactam and aztreonam. A diffuse maculopapular rash developed after the administration of piperacillin. It resolved with discontinuation of the drug and the patient was switched to aztreonam and a very similar rash developed subsequently. In a review of the literature, there are no documented cases of a patient with an allergy to both aztreonam and piperacillin/tazobactam despite in vivo cross-reactivity. Unfortunately, there are no standardized allergy tests for aztreonam or piperacillin. This case, however, does offer the possibility that aztreonam may not always be the right alternative to persons with beta-lactam antibiotic allergies.

Highlights

A 61-year-old Caucasian female presented to the ER with a five-day history of progressively worsening abdominal pain
In reviewing the literature penicillin and cephalosporin IgE mediated cross reactivity is between 1% - 10% depending on which literature and analysis study is referenced
Cross reactivity between the beta lactam class and the monobactam class is lacking in data, with the exception of cross reactivity between ceftazadime and aztreonam [2]

Summary

Introduction

A 61-year-old Caucasian female presented to the ER with a five-day history of progressively worsening abdominal pain. Piperacillin; Aztreonam; Cross; Reactivity; Allergy; Amoxicillin; Drug; Rash; Exanthem; Penicillin; Beta; Lactam; Cephalosporin; IgE; Maculopapular Rash She had gone to her primary care physician two days prior with the complaint of abdominal pain and fever and was treated empirically with oral doxycycline 100 mg P.O. B.I.D. and metronidazole 500 mg P.O. T.I.D. for presumed diverti- (2014) Aztreonam Cell Mediated Hypersensitivity Cross Reactivity with Beta Lactam Antibiotics: The Possibility That It Exists.

Results

Conclusion