β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic
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...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-01-01
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| Series: | Journal of Asthma and Allergy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/beta-lactam-allergy-and-cross-reactivity-a-clinicianrsquos-guide-to-se-peer-reviewed-article-JAA |
| _version_ | 1818612101245042688 |
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| author | Caruso C Valluzzi RL Colantuono S Gaeta F Romano A |
| author_facet | Caruso C Valluzzi RL Colantuono S Gaeta F Romano A |
| author_sort | Caruso C |
| collection | DOAJ |
| description | 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 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 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 |
| first_indexed | 2024-12-16T15:40:52Z |
| format | Article |
| id | doaj.art-4c597f91dfb14d97b0833a262ad53e17 |
| institution | Directory Open Access Journal |
| issn | 1178-6965 |
| language | English |
| last_indexed | 2024-12-16T15:40:52Z |
| publishDate | 2021-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Asthma and Allergy |
| spelling | doaj.art-4c597f91dfb14d97b0833a262ad53e172022-12-21T22:26:00ZengDove Medical PressJournal of Asthma and Allergy1178-69652021-01-01Volume 14314661283β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative AntibioticCaruso CValluzzi RLColantuono SGaeta FRomano ACristiano 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 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 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 testshttps://www.dovepress.com/beta-lactam-allergy-and-cross-reactivity-a-clinicianrsquos-guide-to-se-peer-reviewed-article-JAAaztreonamβ-lactamscarbapenemscephalosporinscross-reactivityhypersensitivitypenicillinsskin tests. |
| spellingShingle | Caruso C Valluzzi RL Colantuono S Gaeta F Romano A β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic Journal of Asthma and Allergy aztreonam β-lactams carbapenems cephalosporins cross-reactivity hypersensitivity penicillins skin tests. |
| title | β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic |
| title_full | β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic |
| title_fullStr | β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic |
| title_full_unstemmed | β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic |
| title_short | β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic |
| title_sort | beta lactam allergy and cross reactivity a clinician rsquo s guide to selecting an alternative antibiotic |
| topic | aztreonam β-lactams carbapenems cephalosporins cross-reactivity hypersensitivity penicillins skin tests. |
| url | https://www.dovepress.com/beta-lactam-allergy-and-cross-reactivity-a-clinicianrsquos-guide-to-se-peer-reviewed-article-JAA |
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