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Cross-Reactivity among Beta-Lactams

  • Antonino RomanoEmail author
  • Francesco Gaeta
  • Maria Francisca Arribas Poves
  • Rocco Luigi Valluzzi
Anaphylaxis and Drug Allergy (DA Khan and M Castells, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anaphylaxis and Drug Allergy

Abstract

Penicillins and cephalosporins are the major classes of beta-lactam (BL) antibiotics in use today and one of the most frequent causes of hypersensitivity reactions to drugs. Monobactams, carbapenems, oxacephems, and beta-lactamase inhibitors constitute the four minor classes of BLs. This review takes into account mainly the prospective studies which evaluated cross-reactivity among BLs in subjects with a well-demonstrated hypersensitivity to a certain class of BLs by performing allergy tests with alternative BLs and, in case of negative results, administering them. In subjects with either IgE-mediated or T-cell-mediated hypersensitivity, cross-reactivity among BLs, particularly among penicillins and among cephalosporins, as well as between penicillins and cephalosporins, seems to be mainly related to structural similarities among their side-chain determinants. Specifically, in penicillin-allergic subjects, cross-reactivity between penicillins and cephalosporins may exceed 30 % when they are administered cephalosporins with identical side chains to those of responsible penicillins. In these subjects, a few prospective studies have demonstrated a rate of cross-reactivity between penicillins and both carbapenems and aztreonam lower than 1 %. With regard to subjects with an IgE-mediated hypersensitivity to cephalosporins, in a single study, about 25 % of the 98 subjects with such hypersensitivity had positive results to penicillins, 3 % to aztreonam, 2 % to imipenem/cilastatin, and 1 % to meropenem. The cross-reactivity related to the selective recognition of the BL ring by IgE or T lymphocytes, which entails positive responses to all BLs tested, appears to be exceptional. Some studies concerning cross-reactivity among BLs have found patterns of allergy-test positivity which cannot be explained by either the common BL ring or by similar or identical side chains, thus indicating the possibility of coexisting sensitivities to different BLs because of prior exposures to them.

Keywords

Beta-lactams Cross-reactivity Hypersensitivity Aztreonam Carbapenems Cephalosporins Penicillins 

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs. Romano, Gaeta, Arribas Poves, and Valluzzi declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Antonino Romano
    • 1
    • 2
    Email author
  • Francesco Gaeta
    • 1
  • Maria Francisca Arribas Poves
    • 3
  • Rocco Luigi Valluzzi
    • 1
  1. 1.Allergy Unit, Complesso Integrato ColumbusRomeItaly
  2. 2.IRCCS Oasi Maria S.S.TroinaItaly
  3. 3.Pharmacology Department, Faculty of PharmacyComplutense UniversityMadridSpain

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