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Tolerance to aztreonam in patients allergic to beta-lactam antibiotics
J M Vega1, M Blanca, J J García
1Research Unit for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain.
Abstract:
To evaluate the safe use of aztreonam (AZT) in patients allergic to penicillins and other beta-lactam antibiotics we studied 29 patients from a group of subjects allergic to beta-lactams, diagnosed by presenting systemic reactions after skin tests or challenge tests. Skin tests with benzylpenicilloyl (BPO), benzylpenicilloate, benzylpenicillin, ampicillin, amoxicillin, cephamandole and AZT, radioallergosorbent test (RAST) to BPO and AZT, RAST inhibition and challenge tests were performed. One patient was skin test-positive to AZT, another patient was RAST AZT-positive. IgE antibodies were specific to AZT as demonstrated by RAST inhibition studies with AZT coupled to epsilon-amino caproic acid. Nevertheless, AZT was unable to inhibit either a pool of sera or individual sera positive to BPO. Although all our 29 patients tolerated the administration of AZT (including those with skin test or RAST positive) and AZT appears to be safe in these subjects, this does not indicate that all beta-lactam-allergic patients tolerate AZT administration.
Insights
Aztreonam (AZT) appears safe for patients with penicillin allergies, even those with positive skin or RAST tests to AZT. However, this study doesn't confirm safety for all beta-lactam-allergic individuals.
Area of Science:
- Clinical Immunology
- Infectious Diseases
- Pharmacology
Background:
- Beta-lactam antibiotics, including penicillins, are common causes of allergic reactions.
- Aztreonam (AZT), a monobactam antibiotic, has a different chemical structure, suggesting potentially lower cross-reactivity with penicillin allergies.
Purpose of the Study:
- To assess the safety and tolerability of aztreonam (AZT) in patients with a documented history of hypersensitivity to penicillins and other beta-lactam antibiotics.
- To investigate potential cross-reactivity between aztreonam and other beta-lactam antibiotics in allergic individuals.
Main Methods:
- Conducted skin tests and radioallergosorbent tests (RAST) for various beta-lactams, including AZT, in 29 beta-lactam-allergic patients.
- Performed RAST inhibition studies to confirm IgE specificity to AZT.
- Administered challenge tests with AZT to evaluate clinical tolerance.
Main Results:
- One patient showed a positive skin test to AZT, and another was RAST-positive for AZT, indicating specific IgE antibodies.
- Despite positive tests, all 29 patients tolerated AZT administration, including those with positive AZT skin or RAST results.
- AZT did not inhibit IgE antibodies specific to benzylpenicilloyl (BPO), suggesting a lack of cross-reactivity in this context.
Conclusions:
- Aztreonam (AZT) appears to be safe for use in most patients with penicillin and other beta-lactam allergies, even those with positive immunological tests to AZT.
- The findings suggest a low risk of cross-reactivity between aztreonam and penicillins.
- Further studies are needed to confirm the safety of aztreonam in the entire spectrum of beta-lactam-allergic patients.