Aminopenicillin-induced exanthema allows treatment with certain cephalosporins or phenoxymethyl penicillin
Open Access
- 16 May 2007
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 60 (1), 107-111
- https://doi.org/10.1093/jac/dkm146
Abstract
Aminopenicillin-induced exanthema poses a problem in the management of infectious diseases. Due to theoretically possible immunological cross-reactivity, all β-lactam drugs, i.e. penicillins, penicillin derivatives and cephalosporins, are usually avoided. The available alternative antibiotics (macrolides, quinolones and glycopeptides) may be less effective, have more side effects, and their use increases medical costs. Moreover, their use contributes to the increasing bacterial resistance to antibiotics. The aim of the study is to demonstrate that patients with aminopenicillin-induced exanthema may receive specific β-lactams for future antibiotic therapy. Skin testing followed by oral challenges to identify β-lactams that are tolerated by patients despite confirmed delayed-type non-immunoglobulin E (IgE)-mediated allergic hypersensitivity to aminopenicillins. Sixty-nine out of 71 patients (97.2%) with non-IgE-mediated allergic hypersensitivity to aminopenicillins tolerate cephalosporins without an aminobenzyl side chain such as cefpodoxime or cefixime and 51 patients (71.8%) also tolerate phenoxymethyl penicillin. The majority of patients with non-IgE-mediated allergic hypersensitivity to aminopenicillins do not cross-react to certain cephalosporins or phenoxymethyl penicillin. Skin and drug challenge tests can be helpful to determine individual cross-reactivity.Keywords
This publication has 35 references indexed in Scilit:
- Skin test evaluation in nonimmediate allergic reactions to penicillinsAllergy, 2004
- Diagnosing Nonimmediate Reactions to Penicillins by in vivo TestsInternational Archives of Allergy and Immunology, 2002
- T Cells Isolated from Positive Epicutaneous Test Reactions to Amoxicillin and Ceftriaxone are Drug Specific and CytotoxicJournal of Investigative Dermatology, 2000
- Skin and laboratory tests in amoxicillin‐ and penicillin‐induced morbilliform skin eruptionClinical and Experimental Allergy, 2000
- Clinical usefulness of patch and challenge tests in the diagnosis of cell-mediated allergy to betalactamsAnnals of Allergy, Asthma & Immunology, 1999
- A diagnostic protocol for evaluating nonimmediate reactions to aminopenicillinsJournal of Allergy and Clinical Immunology, 1999
- Evaluation of adverse cutaneous reactions to aminopenicillins with emphasis on those manifested by maculopapular rashesAllergy, 1995
- A Perspective on Penicillin AllergyArchives of Internal Medicine, 1992
- Evaluation of Skin Test Reactions in Patients with Non‐immediate Type Drug EruptionsThe Journal of Dermatology, 1990
- Drug-Induced Cutaneous ReactionsJama-Journal Of The American Medical Association, 1986