Allergic reactions to penicillins and cephalosporins: diagnosis, assessment of cross-reactivity and management

ABSTRACT

Introduction: Beta-lactams (BL) are the main cause of allergic drug reactions mediated by specific immunological mechanisms. Reactions can be IgE or effector T-cell mediated. The new antigenic determinants are recognized by the immunological system in the context of the common beta-lactam structure or the specific differences in the side chains of the antibiotics of this family plus the protein carrier.

Areas covered: We have reviewed the recent clinical literature concerning new clinical entities, the progress in diagnosis including the difficulties for in in vivo and or in vitro testing as well as the new algorithms proposed for delabelling subjects classified as allergic to beta-lactams, and recommendations for desensitization procedures.

Expert opinion: The knowledge gained over the last years on beta-lactam hypersensitivity has enabled a better understanding and management of cases with allergic reactions to beta-lactams.

KEYWORDS:

• Allergy
• cephalosporins
• cross-reactivity
• diagnosis
• management
• penicillins

Article Highlights

• The chemical structure of penicillins and the rest of BLs antibiotics contributes to the specificity of the immunological response (IgE or Specific T cells).

• Patterns of responses in allergy depend on the prescription habits. In some countries, major and minor determinants of penicillins are still relevant in other side chain-specific reactions predominate.

• In vítro tests for IR have not sufficient sensitivity.

• Programs for de-labelling subjects allergic to BLs has enable to treat many patients false classified as allergic to penicillins.

• Desensitisation continues to be an alternative for giving BLs to those cases required.

Acknowledgments

We thank Ian Johnston for technical assistance in the English version.

Declaration of interest

E Gomez works for Roche Innovation Centre. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by ISCIII Grants, the Network RIRAAF and ARADyAL [RD16/0006/0021, RD16/0006/0024 and RD16/0006/0032], SAF2015-68590-R and FEDER Funds.