β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

Blog Article

Cristiano Caruso,1 Rocco Luigi Valluzzi,2 Stefania Colantuono,1 Francesco Gaeta,1 Antonino Romano3,4 1Allergy Unit, Columbus Hospital, Fondazione Policlinico A.Gemelli, IRCCS, Rome, Italy; 2Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy; 3Oasi Research Institute-IRCCS, Troina, Italy; 4Fondazione Mediterranea G.B.Morgagni, Catania, ItalyCorrespondence: Cristiano Caruso Tel +393348079133Email cristiano.caruso@policlinicogemelli.

itAbstract: β-Lactams which include penicillins, cephalosporins, carbapenems, and monobactams are the most common antibiotic classes reported to cause allergic reactions to drugs.This review is mainly about published studies assessing the cross-reactivity among β-lactams in penicillin- or cephalosporin-allergic subjects by carrying out diagnostic tests with alternative β-lactams and, if appropriate, graded challenges.Several studies demonstrated that cross-reactivity connected Micro Quads with the β-lactam ring, causing positive responses to allergy tests with all β-lactams, is infrequent in subjects with an IgE-mediated allergy and anecdotal in those with a T-cell-mediated allergy.Identities or similarities of β-lactam side-chain structures are mainly responsible for cross-reactivity among these antibiotics.For example, in aminopenicillin-allergic subjects, cross-reactivity with aminocephalosporins could possibly be over 30%.

On the other hand, in Packs a few prospective studies of penicillin-allergic individuals, less than 1% of cases show a cross-reactivity between penicillins and both aztreonam and carbapenems.Particular patterns of allergy-test positivity observed in some studies that assessed cross-reactivity among β-lactams seem to indicate that prior exposures may be responsible for coexisting sensitivities.Therefore, pre-treatment skin tests with the related β-lactams are suggested before administering them via graded challenges to β-lactam-allergic patients who need alternative β-lactams.Keywords: aztreonam, β-lactams, carbapenems, cephalosporins, cross-reactivity, hypersensitivity, penicillins, skin tests.