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Published on: May 31, 2021
Clinical presentation and time course in hypersensitivity reactions to beta-lactams
P J Bousquet1, V Kvedariene, H-B Co-Minh
1Exploration des Allergies, Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier; INSERM U454-IFR3, Hôpital Arnaud de Villeneuve, Montpellier, France.
Background:
beta-lactam hypersensitivity reactions are classified as immediate or nonimmediate. Diagnosis is usually based upon skin tests and provocation challenges.
Objective:
The time course of the reactions in proven beta-lactam hypersensitivities was studied and then correlated with the symptoms to determine the relationship between the clinical presentations and the time course.
Method:
All of the patients who consulted between 1996 and 2004 for a suspected beta-lactam hypersensitivity reaction were studied. Two hundred and ten patients with a proven hypersensitivity reaction diagnosed according to the European Network on Drug Allergy were included in the present study.
Results:
Of the patients, 36.7% had urticaria as a single symptom, 19.1% anaphylaxis without shock, 17.6% anaphylactic shock and 19.1% maculopapular exanthema. Anaphylactic shock and anaphylaxis mostly occurred within 1 h after drug administration. Exanthema mainly occurred after 24 h. Urticaria as a single symptom occurred at any time. A firm diagnosis was determined using immediate-reading skin prick (10.0%) and intradermal tests (38.1%), late-reading skin tests (19.1%) or provocation tests (32.9%).
Conclusion And Clinical Implication:
Depending on the time course of the reaction, three clinical groups were identified: anaphylaxis and anaphylactic shock (immediate reaction); maculopapular exanthema (late reaction) as well as urticaria (immediate and late reaction).
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