Abstract
BackgroundPenicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific β-lactams are scarce and inconsistent. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic.MethodsWe retrospectively evaluated data from 800 consecutive patients with suspected β-lactam hypersensitivity over a period of 11 years in a single German Allergy Center.Resultsβ-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing β-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all β-lactam allergic patients tolerated at least one, usually several alternative substances out of the β-lactam group.ConclusionsWe identified two patterns of β-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type β-lactam hypersensitivity.
Highlights
Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction
Patients were tested with a series of different penicillins and cephalosporins; the concentrations used for patch, prick, and intradermal skin testing are detailed in Additional file 2
In 205 out of total 800 evaluated patients, a diagnosis of β-lactam hypersensitivity could be established in our Allergy Center, based on an overall assessment including history, the clinical reaction and results of testing. β-lactam hypersensitivity could be definitely excluded in the remaining 595 cases by negative serum IgE and negative skin testing followed by challenge of the incriminated β-lactam antibiotic
Summary
Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic. The sheer number of cases impedes thorough diagnostic work-up of all patients claiming to be allergic to β-lactam antibiotics by an allergy specialist. The clinical picture and diagnosis of an allergic reaction induced by penicillin or other β-lactam antibiotics is comprehensively presented in reviews and guidelines [5, 6]. It remains unknown whether all individual β-lactams are regularly associated with the entire clinical spectrum of drug hypersensitivity reactions
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