Abstract
The β-lactam antibiotics comprise four main classes of drugs; penams (penicillins), cephems (cephalosporins), monobactams, and carbapenems. Penicillins can cause all four types of hypersensitivity responses. IgE antibodies in patients’ sera detect a spectrum of antigenic specificities, show heterogeneous recognition and cross-reactive responses, and may distinguish fine structural features, e.g., amoxicilloyl and amoxicillanyl determinants. With a negative history of penicillin allergy, the incidence of positive skin tests is 2–7 %. For skin test-positive patients the risk of an acute allergic reaction ranges from 10 % (negative history) to 50–70 % (positive history). IDTs with delayed reading and patch tests are used to diagnose delayed reactions. Aminolysis of cephalosporins produces unstable intermediates that decompose to penaldate and penamaldate structures resulting in only the R1 side chain remaining from the original molecule. With some allergic patients the R2 side chain and/or the whole cephalosporin molecule are also recognized by IgE antibodies. Testing with penicillins does not reliably predict cephalosporin allergy unless the side chains of the penicillin and the culprit cephalosporin are similar. Aztreonam shows little, if any, cross-reaction with penicillins and cephalosporins. The practice of avoiding imipenem and meropenem therapies in penicillin-allergic patients should be reconsidered. There has been an increase in cases of immediate hypersensitivity to clavulanic acid.
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Further Reading
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Baldo, B.A., Pham, N.H. (2013). β-Lactam Antibiotics. In: Drug Allergy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7261-2_5
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DOI: https://doi.org/10.1007/978-1-4614-7261-2_5
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