Clinical Reviews in Allergy & Immunology

, Volume 24, Issue 3, pp 201–219 | Cite as

Hypersensitivity reactions to beta-lactam antibiotics

  • Roland Solensky
Article

Abstract

Clinicians commonly encounter patients with a history of allergy to penicillin and other beta-lactam antibiotics, since about 10% of the population reports such an allergy. At the same time, it is known that about 90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics. Instead, these patients are treated unnecessarily with alternate broad-spectrum antibiotics, which increases costs and contributes to the development and spread of multiple drug-resistant bacteria.

In the case of penicillin, relevant allergenic determinants that elicit immune responses are known. Hence, validated diagnostic skin testing to detect the presence of drug-specific IgE antibodies is available. For non-penicillin beta-lactams, the immunogenic determinants that are produced by degradation are unknown, and diagnostic skin testing is of more limited value. Ideally, patients with a history of penicillin allergy should be evaluated when they are well and not in immediate need of antibiotic therapy. Patients who are found to be penicillin skin test-negative may be safely treated with all beta-lactam antibiotics. Penicillin skin testpositive patients should only receive a penicillin-class antibiotic via rapid desensitization, and only in cases when an alternative agent cannot be substituted. Penicillin skin test-positive patients may be safely treated with monobactams. The extent of allergic cross-reactivity between penicillin arid cephalosporins/carbapenems is uncertain; therefore penicillin skin test-positive patients should only receive these antibiotics via cautious graded challenge or desensitization.

Identification of patients who erroneously carry a label of beta-lactam allergy leads to improved utilization of antibiotics and slows the spread of multiple drug-resistant bacteria.

Index Entries

Penicilli cephalosporins beta-lactams hypersensitivity skin testing 

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References

  1. 1.
    Gadde, J., Spence, M., Wheeler, B., and Adkinson, N. F. (1993), JAMA 270, 2456–2463.PubMedGoogle Scholar
  2. 2.
    Sogn, D. D., Evans, R., Shepherd, G. M., et al. (1992), Arch. Intern. Med. 152, 1025–1032.PubMedGoogle Scholar
  3. 3.
    Sullivan, T. J., Wedner, H. J., Shatz, G. S., Yecies, L. D., and Parker, C. W. (1981), J. Allergy Clin. Immunol. 68, 171–180.PubMedGoogle Scholar
  4. 4.
    Blanca, M., Torres, M. J., Garcia, J. J., et al. (1999), J. Allergy Clin. Immunol. 103, 918–924.PubMedGoogle Scholar
  5. 5.
    Patriarca, G., Schiavino, D., Nucera, E., and Milani, A. (1996), Invest. Allergol. Clin. Immunol. 6, 162–165.Google Scholar
  6. 6.
    Chandra, R. K., Joglekar, S. A., and Thomas E. (1980), Arch. Dis. Child 55, 857–860.PubMedGoogle Scholar
  7. 7.
    Bigby, M., Jick, S., Jick, H., and Arndt, K. (1986), JAMA 256, 3358–3363.PubMedGoogle Scholar
  8. 8.
    Arndt, K. A. and Jick H. (1976), JAMA 235, 918–922.PubMedGoogle Scholar
  9. 9.
    Idsoe, O., Guthe, T., Willcox, R. R., and DeWeck, A. L. (1968), Bull. WHO 38, 159–188.PubMedGoogle Scholar
  10. 10.
    International Rheumatic Fever Study Group (1991), Lancet 337, 1308–1310.Google Scholar
  11. 11.
    Napoli, D. C. and Neeno T. A. (2000), Pediatr. Asthma Allergy Immunol. 14, 329–332.Google Scholar
  12. 12.
    Lin, R. Y. (1992), Arch. Intern. Med. 152, 930–937.PubMedGoogle Scholar
  13. 13.
    Schuberth, K. C., Lichtenstein, L. M., Kagey-Sobotka, A., Szklo, M., Kwiterovich, K. A., and Valentine, M. D. (1982), J. Pediatr. 102, 1361–1365.Google Scholar
  14. 14.
    Levine, B. B. (1966), N. Engl. J. Med. 275, 1115–1125.PubMedCrossRefGoogle Scholar
  15. 15.
    Kern, R. A. and Wimberley, N. A. (1953), Am. J. Med. Sci. 226, 357.PubMedGoogle Scholar
  16. 16.
    Green, G. R., Rosenblum A. H., and Sweet, L. C. (1977), J. Allergy Clin. Immunol. 60, 339–345.PubMedGoogle Scholar
  17. 17.
    Bock, S. A., Munoz-Furlong, A., and Sampson, H. A. (2001), J. Allergy Clin. Immunol. 107, 191–193.PubMedGoogle Scholar
  18. 18.
    Sampson, H. A., Mendelson, L., and Rosen, J. P. (1992), N. Engl. J. Med. 327, 380–384.PubMedCrossRefGoogle Scholar
  19. 19.
    Patel, B. M. (1967), Pediatrics 40, 910–911.PubMedGoogle Scholar
  20. 20.
    Park, B. K., Pirmohamed, M., and Kitteringham, N. R. (1992), Br. J. Clin. Pharmacol. 34, 377–395.PubMedGoogle Scholar
  21. 21.
    Adkinson, N. F. (1998), Drug allergy, in Allergy: Principles and Practice, 5th ed., Middleton, E., Reed, C. E., Ellis, E. F., Adkinson, N. J., Yunginger, J. W., and Busse, W. W., eds., Mosby, St. Louis, pp. 1212–1224.Google Scholar
  22. 22.
    Gorevic, P. D. (1997), Drug allergy, in Allergy, 2nd ed., Kaplan, A. P., ed., W.B. Saunders, Philadelphia, pp. 620–643.Google Scholar
  23. 23.
    Adkinson, N. F. (1984), J. Allergy Clin. Immunol. 74, 567–572.PubMedGoogle Scholar
  24. 24.
    Moss, R. B. (1991), Clin. Rev. Allergy 9, 211–229.PubMedGoogle Scholar
  25. 25.
    Attaway, N. J., Jasin, H. M., and Sullivan, T. J. (1991), J. Allergy Clin. Immunol. 87, 227.Google Scholar
  26. 26.
    Kurtz, K. M., Beatty, T. L., and Adkinson, N. F. (2000), J. Allery Clin. Immunol. 105, 184–185.Google Scholar
  27. 27.
    Sullivan, T. J. and Wedner, H. J. (1992), Drug allergy, in Allergy: Theory and Practice, 2nd ed., Korenblat, P. E. and Wedner, H. J., eds., W.B. Saunders, Philadelphia, pp. 541–559.Google Scholar
  28. 28.
    Kamada, M. M., Twarog, F., and Leung, D. Y. M. (1991), Allergy Proc. 12, 347–350.PubMedGoogle Scholar
  29. 29.
    Moseley, E. K. and Sullivan, T. J. (1991) J. Allergy Clin. Immunol. 87, 226.Google Scholar
  30. 30.
    Smith, J. W., Johnson, J. E., and Cliff, L. E. (1966), N. Engl. J. Med. 274, 998–1002.PubMedCrossRefGoogle Scholar
  31. 31.
    Sullivan, T., Jong, R. C., and Gilliam, L. K. (1989), J. Allergy Clin. Immunol. 83, 270.Google Scholar
  32. 32.
    Khoury, L. and Warrington, R. (1996), J. Allergy Clin. Immunol. 98, 462–464.PubMedGoogle Scholar
  33. 33.
    Park, B. K., Coleman, J. W., and Kitteringham, N. R. (1987), Biochem. Pharmacol. 36, 581–590.PubMedGoogle Scholar
  34. 34.
    Solensky, R. and Gruchalla, R. S. (2001), Nonanaphylactic drug disorders, in Inflammatory Mechanisms in Allergic Diseases Zweiman, B. and Schwartz, L. B., eds., Marcel Dekker, New York, pp. 411–433.Google Scholar
  35. 35.
    Parker, C. W., deWeck, A. L., Kern, M., and Eisen, H. N. (1962), J. Exp. Med. 115, 803–819.PubMedGoogle Scholar
  36. 36.
    Levine, B. B. and Ovary, Z. (1961), J. Exp. Med. 114, 875–904.PubMedGoogle Scholar
  37. 37.
    Levine, B. B. and Redmond, A. P. (1969), Int. Arch. Allergy Appl. Immunol. 35, 445–455.PubMedGoogle Scholar
  38. 38.
    Wickern, G. M., Nish, W. A., Bitner, A. S., and Freeman, T. M. (1994), J. Allergy Clin. Immunol. 94, 725–731.PubMedGoogle Scholar
  39. 39.
    Ressler, C., Neag, P. M., and Mendelson, L. M. (1985), J. Pharm. Sci. 74, 448–454.PubMedGoogle Scholar
  40. 40.
    Martin, D. F., Gardner, K. H., and Gruchalla, R. S. (2000), J. Allergy Clin. Immunol. 104, S346.Google Scholar
  41. 41.
    Blanca, M., Perez, E., Garcia, J. et al. (1988), Allergy 43, 508–510.PubMedGoogle Scholar
  42. 42.
    Blanca, M., Vega, J. M., Garcia, J., et al. (1990), Clin. Exp. Allergy 20, 475–481.PubMedGoogle Scholar
  43. 43.
    Solley, G. O., Gleich, G. J., and VanDellen, R. G. (1982), J. Allergy Clin. Immunol. 69, 238–244.PubMedGoogle Scholar
  44. 44.
    Vega, J. M., Blanca, M., Garcia, J. J., et al. (1994), Allergy 49, 317–322.PubMedGoogle Scholar
  45. 45.
    Marcos Bravo, L., Luna Ortiz, I., and Vazquez Gonzalez, R. (1995), Allergy 50, 359–361.PubMedGoogle Scholar
  46. 46.
    Miranda, A., Blanca, M., Vega, J. M., et al. (1996), J. Allergy Clin. Immunol. 98, 671–677.PubMedGoogle Scholar
  47. 47.
    Sastre, J., Quijano, L. D., Novalbos, A., et al. (1996), Allergy 51, 383–386.PubMedGoogle Scholar
  48. 48.
    Valyasevi, M. A. and VanDellen, R. G. (2000), Ann. Allergy Asthma Immunol. 85, 363–365.PubMedGoogle Scholar
  49. 49.
    Bernstein, I. L., Gruchalla, R. S., Lee, R. E., Nicklas, R. A., and Dykewicz, M. S. (1999), Ann. Allergy Asthma Immunol. 83, 665–700.Google Scholar
  50. 50.
    Mendelson, L. M., Ressler, C., Rosen, J. P., and Selcow, J. E. (1984), J. Allergy Clin. Immunol. 73, 76–81.PubMedGoogle Scholar
  51. 51.
    DeSwarte, R. D. and Patterson, R. (1997), Drug allergy, in Allergic Diseases: Diagnosis and Management, 5th ed., Patterson, R., Grammer, L. C., and Greenberger, P. A., eds., Lippincott-Raven, Philadelphia, pp. 317–412.Google Scholar
  52. 52.
    Shepherd, G. (1997), J. Allergy Clin. Immunol. 99, S134.Google Scholar
  53. 53.
    Adkinson, N. F., Thompson, W. L., Maddrey, W. C., and Lichtenstein, L. M. (1971), N. Engl. J. Med. 46, 457–460.Google Scholar
  54. 54.
    Levine, B. B. and Zolov, D. M. (1969), J. Allergy 43, 231–244.PubMedGoogle Scholar
  55. 55.
    Hunt, K. J., Valentine, M. D., Sobotka, A. K., Benton, A. W., Amodio, F. J., and Lichtenstein, L. M. (1978), N. Engl. J. Med. 299, 157–161.PubMedCrossRefGoogle Scholar
  56. 56.
    Girard, J. P. (1968), Int. Arch. Allergy 33, 428–438.PubMedGoogle Scholar
  57. 57.
    Romano, A., Quaratino, D., Venuti, A., Venemalm, L., Mayorga, C., and Blanca, M. (1998), J. Allergy Clin. Immunol. 101, 564–565.PubMedGoogle Scholar
  58. 58.
    Romano, A., Quaratino, D., Venemalm, L., Torres, M. J., Venuti, A., and Blanca, M. (1999), J. Allergy Clin. Immunol. 104, 1113–1114.PubMedGoogle Scholar
  59. 59.
    Romano, A., Mayorga, C., Torres, M. J., et al. (2000), J. Allergy Clin. Immunol. 106, 1177–1183.PubMedGoogle Scholar
  60. 60.
    Novalbos, A., Sastre, J., Cuesta, J., et al. (2001), Clin. Exp. Allergy 31, 438–443.PubMedGoogle Scholar
  61. 61.
    Empedrad, R. B., Earl H. S., and Gruchalla, R. S. (2000), J. Allergy Clin. Immunol. 105, S272.Google Scholar
  62. 62.
    Saxon, A., Hassner, A., Swabb, E. A., Wheeler, B., and Adkinson, N. F. (1984), J. Infect. Dis. 149, 16–22.PubMedGoogle Scholar
  63. 63.
    Saxon, A., Adelman, D. C., Patel, A., Hajdu, R., and Calandra, G. B. (1988), J. Allergy Clin. Immunol. 82, 213–217.PubMedGoogle Scholar
  64. 64.
    Parker, C. W. (1972), Practical aspects of diagnosis and treatment of patients who are hypersensitive to drugs, in Hypersensitivity to Drugs, Samter, M. and Parker, C. W., eds., Pergamon Press, New York, pp. 367–394.Google Scholar
  65. 65.
    Solensky, R., Earl, H. S., and Gruchalla, R. S. (2000), Ann. Allergy Asthma Immunol. 84, 329–333.PubMedGoogle Scholar
  66. 66.
    Lee, C. E., Zembower, T. R., Fotis, M. A., et al. (2000), Arch. Intern. Med. 160, 2819–2822.PubMedGoogle Scholar
  67. 67.
    Bonafede, M. and Rice, L. B. (1997) J. Lab. Clin. Med. 130, 558–566.PubMedGoogle Scholar
  68. 68.
    Murray, B. E. (2000), N. Engl. J. Med. 342, 710–721.PubMedGoogle Scholar
  69. 69.
    Rao, G. G. (1998), Drugs 55, 323–330.PubMedGoogle Scholar
  70. 70.
    Kraemer, M. J., Caprye-Boos, H., and Berman, H. S. (1987), West J. Med. 146, 697–700.PubMedGoogle Scholar
  71. 71.
    Hospital Infection Control Practices Advisory Committee (HICPAC) (1995), MMWR 44(RR-12), 1–13.Google Scholar
  72. 72.
    Harris, A. D., Sauberman, L., Kabbash, L., Greineder, D. K., and Samore, M. H. (1999), Am. J. Med. 107, 166–168.PubMedGoogle Scholar
  73. 73.
    Arroliga, M. E., Wagner, W., Bobek, M. B., Hoffman-Hogg, L., Gordon, S. M., and Arroliga, A. C. (2000), Chest 118, 1106–1108.PubMedGoogle Scholar
  74. 74.
    Li, J. T., Markus, P. J., Osmon, D. R., Estes, L., Gosselin, V. A., and Hanssen, A. D. (2000), Mayo Clin. Proc. 75, 902–906.PubMedGoogle Scholar
  75. 75.
    Macy, E. (1998), J. Allergy Clin. Immunol. 102, 281–285.PubMedGoogle Scholar
  76. 76.
    Perencevich, E. N., Weller, P. F., Samore, M. H., and Harris, A. D. (2001), Clin. Infect. Dis. 32, 317–319.PubMedGoogle Scholar
  77. 77.
    Solensky, R., Earl, H. S., and Gruchalla, R. S. (2002), Arch. Intern. Med., 162, 822–826.PubMedGoogle Scholar
  78. 78.
    Parker, P. J., Parrinello, J. T., Condemi, J. J., and Rosenfeld, S. I. (1991), J. Allergy Clin. Immunol. 88, 213–217.PubMedGoogle Scholar
  79. 79.
    Earl, H. S., Stark, B. J., and Sullivan, T. J. (1987), J. Allergy Clin. Immunol. 79, 200.Google Scholar
  80. 80.
    Solensky, R., Earl, H. S., and Gruchalla, R. S. (2000), Ann. Allergy Asthma Immunol. 85, 195–199.PubMedCrossRefGoogle Scholar
  81. 81.
    Abraham, G. N., Petz, L. D., and Fudenberg, H. H. (1968), Clin. Exp. Immunol. 3, 343–357.PubMedGoogle Scholar
  82. 82.
    Assem, E. S. K. and Vickers, M. R. (1974), Immunology 27, 255–269.PubMedGoogle Scholar
  83. 83.
    Batchelor, F. R., Dewdney, J. M., Weston, R. D., and Wheeler, A. W. (1966), Immunology 10, 21–33.PubMedGoogle Scholar
  84. 84.
    Levine, B. B. (1973), J. Infect. Dis. 128, S364-S366.PubMedGoogle Scholar
  85. 85.
    Shibata, K., Atsumi, T., Horiuchi, Y., and Mashimo K. (1966), Nature 212, 419–420.PubMedGoogle Scholar
  86. 86.
    Petz, L. D. (1978), J. Infect. Dis. 137(Suppl.), S74-S79.PubMedGoogle Scholar
  87. 87.
    Dash, C. H. (1975), J. Antimicrob. Chemother. 1 Suppl, 107–118.Google Scholar
  88. 88.
    Warrington, R. J., Simons, F. E. R., Ho, H. W., Gorski, B. A., and Tse, K. S. (1978), Can. Med. Assoc. J. 118, 787–791.PubMedGoogle Scholar
  89. 89.
    Saxon, A., Beall, G. N., Rohr, A. S., and Adelman, D. C. (1987), Ann. Intern. Med. 107, 204–215.PubMedGoogle Scholar
  90. 90.
    Blanca, M., Fernandez, J., Miranda, A., et al. (1989), J. Allergy Clin. Immunol. 83, 381–385.PubMedGoogle Scholar
  91. 91.
    Shepherd, G. M. and Burton, D. A. (1993), J. Allergy Clin. Immunol. 91, 262.Google Scholar
  92. 92.
    Audicana, M., Bernaola, G., Urrutia, I., et al. (1994), Allergy 49, 108–113.PubMedGoogle Scholar
  93. 93.
    Grieco, M. H. (1967), Arch. Intern. Med. 119, 141–146.Google Scholar
  94. 94.
    Rothschild, P. D. and Doty, D. B. (1966), JAMA 196, 372–373.Google Scholar
  95. 95.
    Scholand, J. F., Tennenbaum, J. I., and Cerilli, G. J. (1968), JAMA 206, 130–132.PubMedGoogle Scholar
  96. 96.
    Spruill, F. G., Minette, L. J., and Sturner, W. Q. (1974), JAMA 229, 440–441.PubMedGoogle Scholar
  97. 97.
    Thoburn, R., Johnson, J. E., and Cluff, L. E. (1966), JAMA 198, 345–348.PubMedGoogle Scholar
  98. 98.
    Kabins, S. A., Eisenstein, B., and Cohen, S. (1965), JAMA 193, 165–166.PubMedGoogle Scholar
  99. 99.
    Pederson-Bjergaard, J. (1967), Acta Allergol. 22, 299–306.Google Scholar
  100. 100.
    Igea, J. M., Fraj, J., Davila, I., Cuevas, M., Cuesta, J., and Hinojosa, M. (1992), Ann. Allergy 68, 515–519.PubMedGoogle Scholar
  101. 101.
    Perez Pimiento, A., Gomez Martinez, M., Minguez Mena, A., Trampal Gonzalez, A., de Paz Arranz, S., and Rodriguez Mosquera, M. (1997), Allergy 53, 624–625.Google Scholar
  102. 102.
    Vega, J. M., Blanca, M., Garcia, J. J., et al. (1991), Allergy 46, 196–202.PubMedGoogle Scholar
  103. 103.
    Adkinson, N. F. (1990), Am. J. Med. 88(Suppl. 3C), S3-S14.Google Scholar
  104. 104.
    Adkinson, N. F., Saxon, A., Spence, M. R., and Swabb, E. A. (1985), Rev. Infect. Dis. 7(Suppl. 4), S613-S621.PubMedGoogle Scholar
  105. 105.
    Adkinson, N. F., Swabb, E. A., and Sugerman, A. A. (1984), Antimicrob. Agents Chemother. 25, 93–97.PubMedGoogle Scholar
  106. 106.
    Saxon, A., Swabb, E. A., and Adkinson, N. F. (1985), Am. J. Med. 78(Suppl. 2A), 19–26.PubMedGoogle Scholar
  107. 107.
    Moss, R. B., McClelland, E., Williams, R. R., Hilman, B. C., Rubio, T., and Adkinson, N. F. (1991), Rev. Infect. Dis. 13(Suppl. 7), S598-S607.PubMedGoogle Scholar
  108. 108.
    Graninger, W., Pirich, K., Schindler, I., Breyer, S., and Laggner, A. (1985), Chemioterapia 4(Suppl. 1), 64–66.Google Scholar
  109. 109.
    Loria, R. C., Finnety, N., and Wedner, H. (1989), J. Allergy Clin. Immunol. 83, 735–737.PubMedGoogle Scholar
  110. 110.
    Iglesias Cadarso, A., Saez Jimenez, S. A., Vidal Pan, C., and Rodriquez Mosquera, M. (1990), Lancet 336, 746–747.PubMedGoogle Scholar
  111. 111.
    de la Fuente Prieto, R., Armentia Medina, A., Sanchez Palla, P., Diez Perez, J. M., Sanchis Merino, M. E., and Fernandez Garcia, A. (1993), Allergy 48, 634–636.PubMedGoogle Scholar
  112. 112.
    Chen, Z., Baur, X., Kutscha-Lissberg, F., and Merget, R. (2000), Allergy 55, 92–93.PubMedGoogle Scholar
  113. 113.
    McConnell, S. A., Penzak, S. R., Warmack, T. S., Anaissie, E. J., and Gubbins, P. O. (2000), Clin. Infect. Dis. 31, 1512–1514.PubMedGoogle Scholar
  114. 114.
    Sullivan, T. J. (1982), J. Allergy Clin. Immunol. 69, 500–508.PubMedGoogle Scholar
  115. 115.
    Borish, L., Tamir, R., and Rosenwasser, L.J. (1987), J. Allergy Clin. Immunol. 80, 314–319.PubMedGoogle Scholar
  116. 116.
    Chisholm, C. A., Katz, V. L., McDonald, T. L., and Bowes, W. A. (1997), Am. J. Perinatol. 14, 553–554.PubMedCrossRefGoogle Scholar
  117. 117.
    Stark, B. J., Earl, H. S., Gross, G. N., Lumry, W. R., Goodman, E. L., and Sullivan, T. J. (1987), J. Allergy Clin. Immunol. 79, 523–532.PubMedGoogle Scholar
  118. 118.
    Sullivan, T. J., Yecies, L. D., Shatz, G. S., Parker, C. W., and Wedner, H. J. (1982), J. Allergy Clin. Immunol. 69, 275–282.PubMedGoogle Scholar
  119. 119.
    Wendel, G. D., Stark, B. J., Jamison, R. B., Molina, R. D., and Sullivan, T. J. (1985), N. Engl. J. Med. 312, 1229–1232.PubMedCrossRefGoogle Scholar
  120. 120.
    Ghosal, S. and Taylor, C. J. (1997), J. Antimicrob. Chemother. 39, 556–557.PubMedGoogle Scholar
  121. 121.
    Earl, H. S. and Sullivan, T. J. (1987), J. Allergy Clin. Immunol. 79, 477–483.PubMedGoogle Scholar
  122. 122.
    Moss, R. B. (1991), J. Allergy Clin. Immunol. 87, 78–88.PubMedGoogle Scholar
  123. 123.
    Brown, L. A., Goldberg, N. D., and Shearer, W. T. (1982), J. Allergy Clin. Immunol. 69, 51–54.PubMedGoogle Scholar

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© Humana Press Inc. 2003

Authors and Affiliations

  • Roland Solensky
    • 1
  1. 1.The Corvallis ClinicCorvallis

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