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

  • Antonino Romano
  • Rocco Luigi Valluzzi
  • Cristiano Caruso
  • Michela Maggioletti
  • Francesco Gaeta
Allergic Skin Diseases (L Fonacier, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Allergic Skin Diseases

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.

Keywords

Beta-lactam allergy Challenges Cross-reactivity Non-immediate reactions Skin tests Tolerability 

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

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs. Romano, Valluzzi, Caruso, Maggioletti, and Gaeta declare no conflicts of interest relevant to this manuscript.

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 2017

Authors and Affiliations

  • Antonino Romano
    • 1
    • 2
  • Rocco Luigi Valluzzi
    • 1
    • 3
  • Cristiano Caruso
    • 1
  • Michela Maggioletti
    • 1
  • Francesco Gaeta
    • 1
  1. 1.Allergy Unit, Presidio ColumbusRomeItaly
  2. 2.IRCCS Oasi Maria S.STroinaItaly
  3. 3.Department of Pediatrics, Division of AllergyPediatric Hospital Bambino GesùRomeItaly

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