Antibiotic allergy

Area of Science:

• Clinical Immunology
• Pharmacology
• Allergy and Immunology

Background:

• Antibiotics are frequently administered perioperatively, accounting for 15% of anaphylactic reactions.
• Anaphylaxis is commonly associated with penicillin and cephalosporin antibiotics.
• Managing patients with reported antibiotic allergies is a frequent clinical challenge.

Purpose of the Study:

• To outline the diagnostic approach for suspected antibiotic-induced anaphylaxis.
• To emphasize the importance of allergological work-up for antibiotic hypersensitivity.
• To guide the management of patients with a history of antibiotic allergic reactions.

Main Methods:

• Diagnosis relies on a comprehensive allergological work-up, including detailed clinical history.
• In vitro tests are insufficient; skin tests and drug provocation tests are crucial.
• Assessing cross-reactivity between antibiotic classes like penicillins and cephalosporins is essential.

Main Results:

• Immediate penicillin allergy diagnosis necessitates skin testing with alternative antibiotics (cephalosporin, carbapenem, aztreonam).
• Negative skin tests allow for graded drug administration in a monitored setting.
• This approach confirms or refutes the allergic nature of reported reactions.

Conclusions:

• A rigorous allergological work-up is mandatory for diagnosing antibiotic hypersensitivity.
• Skin testing and drug provocation are key to confirming or invalidating reported allergic reactions.
• Careful evaluation enables safe re-administration of necessary antibiotics, considering cross-reactivity.