Beta-Lactam Hypersensitivity and Cross-Reactivity

@article{Terico2014BetaLactamHA,
  title={Beta-Lactam Hypersensitivity and Cross-Reactivity},
  author={Adrienne T. Terico and Jason C. Gallagher},
  journal={Journal of Pharmacy Practice},
  year={2014},
  volume={27},
  pages={530 - 544}
}
Penicillin is the most frequently reported cause of drug allergy, and cross-reactivity of penicillins with other beta-lactam antibiotics is an area of debate. [...] Key Method A MEDLINE search was conducted from 1950 to October 2013, and selected references from review articles were also evaluated. There is a wide variety in reported incidences of cross-reactivity between penicillins and cephalosporins or carbapenems, with early retrospective studies suggesting up to 41.7% and 47.4% cross-reactivity…Expand
Cross-reactivity in b-Lactam Allergy
b-Lactam drugs (penicillins, amoxicillin, and cephalosporins) account for 42.6% of all severe drug-induced anaphylaxis. In this review, we focus on clinically significant immunologic crossreactivity
Cross-reactivity in β-Lactam Allergy.
TLDR
It is concluded that there is ample evidence to allow the safe use of cephalosporins in patients with isolated confirmed penicillin or amoxicillin allergy, and the structural involvement of the R1 and R2 chemical side chains of the cep Halosporin causing IgE-mediated cross-reactivity with penicillins and other cep HALsporins is debated.
Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity
TLDR
Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated and be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cep Khalosporins are brought to market.
Overview and Insights into Carbapenem Allergy
TLDR
Insight into carbapenem allergies is provided, describing the overall incidence, risk factors, and in-class cross-sensitivity, suggesting that an alternative carbapENem may cautiously be used in patients with a reported carbAPenem allergy.
β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules
TLDR
This data indicates that type I hypersensitivity cross-reactivity between β-lactam antibiotics is due to side chain similarity and not the common β- lactam ring, which is a major cause of uncertainty in previous studies.
Evaluation of Clinical Properties and Diagnostic Test Results of Cephalosporin Allergy in Children
TLDR
Cephalosporin allergy has been confirmed in approximately one-fourth of the patients evaluated for suspected cephalic allergy, significantly more common among patients who were older, had immediate reactions, and had taken the drug parenterally.
Inappropriate Use of Aztreonam.
TLDR
Aztreonam should be avoided, except in the case of a true IgE-mediated allergic reaction, except for patients with a reported penicillin allergy.
The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings in Immunocompromised Cancer Patients
TLDR
This study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies, and resulted in improved aztreonam stewardship and significant cost savings.
Antibiotic Hypersensitivity Mechanisms
TLDR
The mechanisms of different types of allergic reactions to commonly prescribed antibiotics are described and recommendations for management are offered.
Confronting the Challenge of Beta-Lactam Allergies: A Quasi-Experimental Study Assessing Impact of Pharmacy-Led Interventions
TLDR
Multidisciplinary education and local guideline implementation led by pharmacists may improve allergy documentation and antibiotic selection in patients with reported beta-lactam allergies.
...
1
2
3
4
...

References

SHOWING 1-10 OF 99 REFERENCES
Allergic Cross-Sensitivity Between Penicillin, Carbapenem, and Monobactam Antibiotics: What are the Chances?
TLDR
Although variability in cross-reactivity rates between β-lactam classes exists in the literature, the practice of avoiding carbapenems in penicillin-allergic patients should be reconsidered.
Immediate hypersensitivity reactions to beta-lactam antibiotics.
TLDR
The results of in-vivo challenges of patients with IgE to Penicillin suggest the incidence of reactivity of cephalosporins in patients allergic to penicillin is less than generally appreciated.
Immunogenicity and cross-allergenicity of aztreonam.
  • N. Adkinson
  • Medicine
    The American journal of medicine
  • 1990
TLDR
If it is confirmed that monobactams such as aztreonam are minimally cross-reactive, well-tolerated by subjects allergic to other beta-lactam antibiotics, and only weakly immunogenic, fewer allergic reactions may be associated with antimicrobial therapy in the future than have been seen with the other available beta- lactam antibiotic drugs.
Lack of cross-reactivity between aztreonam , a monobactam antibiotic, and penicillin in penicillin-allergic subjects.
TLDR
In vivo data suggest that there is no cross-reactivity between IgE antibodies to penicillin and aztreonam and provide a basis for investigating the therapeutic use of monobactams in patients who are allergic to Penicillin.
IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of penicillins, monobactams, and carbapenems.
TLDR
In subjects with cephalosporin allergy who especially require alternative β-lactams, pretreatment skin tests are advisable because negative results indicate tolerability of the β- lactam concerned.
Cross-reactivity between penicillins and cephalosporins: clinical and immunologic studies.
TLDR
It is concluded that consideration of side chain structures can help to predict possible cross-reactions between penicillins and cephalosporins, but carefully controlled challenge tests are advisable before penicillin-allergic patients are treated with cep Khaloridine.
Immunologic cross-reactivity between penicillins and cephalosporins: a review.
  • L. Petz
  • Biology, Medicine
    The Journal of infectious diseases
  • 1978
TLDR
There is evidence of specific immune response to cephalosporins that indicates independently acquired hypersensitivity rather than cross-reactivity in some patients, and this finding is impossible to determine because penicillin-allergic patients have an increased incidence of hypersensitivity reactions to drugs immunologically unrelated to penicillins.
Sensitization to aztreonam and cross-reactivity with other beta-lactam antibiotics in high-risk patients with cystic fibrosis.
  • R. Moss
  • Medicine
    The Journal of allergy and clinical immunology
  • 1991
The immunogenicity, allergenicity, and cross-reactivity of aztreonam were investigated in 21 patients with cystic fibrosis (CF) (aged 5 to 39 years) with well-documented histories of allergic
Cephalosporin use in treatment of patients with penicillin allergies.
TLDR
Recent data suggest that the incidence of cross-reactivity among penicillins and cephalosporins is lower than historically reported, and Pharmacists should be aware that cep Halosporin cross- reactivity in a penicillin-allergic patient is not necessarily a class effect.
Cephalexin tolerated despite delayed aminopenicillin reactions
TLDR
Skin testing, patch testing, and oral challenges to examine the potential immunologic cross-reactivity in patients with previously documented delayed intradermal skin response to ampicillin suggested that skin and patch tests complement each other but are not mutually exclusive, and a positive reaction on either test should be considered signi®cant.
...
1
2
3
4
5
...