Prediction of hypersensitivity to antibiotics: what factors need to be considered?

Abstract

This review focuses on the epidemiology and different risk factors related to the development of hypersensitivity reactions to antibiotics, with a focus on betalactams and fluoroquinolones, the compounds most frequently involved in these reactions, due to their high level of consumption. The true prevalence of allergic drug reactions is unknown and the corresponding morbidity, mortality and associated economic costs are often underestimated. It is reported that multiple risk factors, related to both the drug and the patient, can modify the clinical expression of immune-mediated drug reactions. These include the chemical properties, molecular weight and administration route of the drug and the age, gender, concomitant diseases and genetic factors of the patient.

Keywords::

• allergic reactions
• antibiotics
• drug related
• patient related
• risk factors

Financial & competing interests disclosure

The authors were supported by Instituto de Salud Carlos III (Ministry of Economy and Competitiveness) and Junta de Andalucía. 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.

The authors thank James Parker for help with the English language version of the manuscript.

Key issues

• • Multiple risk factors have been shown to modify the clinical expression of immunologic drug reactions. These factors can be related with the drug or with the subject.

• • Drug-related risk factors are: molecular weight and chemical properties, mode and route of administration, contaminating and excipient substances.

• • Host-related risk factors are: age, gender, prior history of allergic reactions, atopy, concomitant diseases, genetic factors.

• • Beta-lactams (BLs) are the antibiotics most frequently involved in immunologic drug reactions. The consumption changes toward the combination amoxicillin and clavulanic acid (AX-CLV) has led to an increase in the prevalence of allergic reactions to CLV.

• • Hypersensitivity to fluoroquinolone (FQ) antibiotics have shown an important increase mainly related with their very high consumption.

• • Several studies have shown an association between female sex and penicillin allergy and a number of genetic associations with immediate allergic reaction to BL antibiotics related with IL-4, IL-13 and the IL-4 receptor-α chain gene.

• • Patients who had previous hypersensitivity to BLs are more likely to be confirmed as having immediate hypersensitivity to FQs.