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Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis

  • Allergic Skin Diseases (L Fonacier, Section Editor)
  • Published:
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Abstract

Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.

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Abbreviations

AGEP::

Acute generalized exanthematous pustulosis

AX/CLAV::

Amoxicillin plus clavulanic acid

BP-OL::

Benzylpenicilloyl-octa-L-lysine

CADR::

Cutaneous adverse drug reaction(s)

DiHS::

Drug-induced hypersensitivity syndrome

DPT::

Drug provocation test(s)

DRESS::

Drug reaction with eosinophilia and systemic symptoms

ELISpot::

Enzyme-linked immunosorbent spot

ENDA::

European network for drug allergy

FDE::

Fixed drug eruption(s)

IDT::

Intradermal test(s)

LTT::

Lymphocyte transformation test(s)

MD::

Minor determinant

MDM::

Minor determinant mixture

MPE::

Maculopapular exanthema(s)

PPL::

Penicilloyl-poly-L-lysine

PT::

Patch test(s)

SDRIFE::

Symmetrical drug-related intertriginous and flexural exanthema

SJS::

Stevens-Johnson syndrome

SPT::

Skin prick test(s)

ST::

Skin test(s)

TEN::

Toxic epidermal necrolysis

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Authors and Affiliations

  1. Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy

    Antonino Romano, Rocco Luigi Valluzzi, Cristiano Caruso, Michela Maggioletti & Francesco Gaeta

  2. IRCCS Oasi Maria S.S, Troina, Italy

    Antonino Romano

  3. Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy

    Rocco Luigi Valluzzi

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  1. Antonino Romano
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Romano, A., Valluzzi, R.L., Caruso, C. et al. Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis. Curr Allergy Asthma Rep 17, 23 (2017). https://doi.org/10.1007/s11882-017-0691-4

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