Penicillin and Cephalosporin-Induced Anaphylaxis: an Update

Abstract

Beta-lactams (BL) are the most widely used antibiotics and the first-choice drugs for many bacterial infections. Their consumption has increased in the last decades being now three times higher than the second most highly consumed group. However, they have a high potential for inducing allergic reactions, being the compounds most frequently involved in drug reactions induced by specific immunological mechanisms. The purpose of this review is to summarize the sensitization patterns, the methods used for diagnosing, and the management of BL-induced anaphylaxis. BL can cause severe reactions such as anaphylaxis; in fact, they have been estimated to account for 75% of all fatal anaphylactic episodes in the USA. As a result, physicians often recommend individuals reporting previous reactions to a given BL to avoid all others in the future. However, we consider this practice to be outdated and in need of revision. The decision of what drugs to recommend should be made based on our knowledge of cross-reactivity between BL groups, based on clinical data and chemical structure. A complete and accurate diagnostic workup must be performed to confirm such cross-reactivity or lack thereof. Our improved knowledge regarding cross-reactivity coincides with recent improvements of in vitro tests, which has decreased the need to perform potentially risky procedures such as drug provocation tests in some situations. This will allow physicians to re-evaluate previous cases and lead to an increase in their therapeutic arsenal to fight against infections. This review summarizes the complex diagnostic approach and management of BL-induced anaphylaxis focusing in recommendation of alternative BL according to the cross-reactivity between BL groups based on clinical data and chemical structure.