Predominant patterns of beta-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins

Please always quote using this URN: urn:nbn:de:bvb:20-opus-231306
  • Background Penicillins and other beta-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific beta-lactams are scarce and inconsistent. We aimed to determine patterns of beta-latam allergy, i.e. the association of a clinical reaction type with a specific beta-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected beta-lactam hypersensitivity over a period of 11 years in a single GermanBackground Penicillins and other beta-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific beta-lactams are scarce and inconsistent. We aimed to determine patterns of beta-latam allergy, i.e. the association of a clinical reaction type with a specific beta-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected beta-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results beta-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 beta-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 beta-lactam allergic patients tolerated at least one, usually several alternative substances out of the beta-lactam group. Conclusions We identified two patterns of beta-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 beta-lactam hypersensitivity.show moreshow less

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Metadaten
Author: Philipp Schrüfer, Knut Brockow, Johanna Stoevesandt, Axel TrautmannORCiD
URN:urn:nbn:de:bvb:20-opus-231306
Document Type:Journal article
Faculties:Medizinische Fakultät / Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie
Language:English
Parent Title (English):Allergy, Asthma & Clinical Immunology
Year of Completion:2020
Volume:16
Article Number:102
Source:Allergy, Asthma & Clinical Immunology (2020) 16:102. https://doi.org/10.1186/s13223-020-00488-0
DOI:https://doi.org/10.1186/s13223-020-00488-0
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:amoxicillin; ampicillin; angioedema; drug adverse reaction; drug allergy; drug hypersensitivity; penicillin allergy; penicillin hypersensitivity; urticaria
Release Date:2021/04/21
Open-Access-Publikationsfonds / Förderzeitraum 2020
Licence (German):License LogoCC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International