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Antibiotic allergy

S Caimmi1, D Caimmi, E Lombardi

  • 1Department of Pediatrics, University of Pavia, Italy. sissi_del_78@hotmail.com

International Journal of Immunopathology and Pharmacology
|October 22, 2011
PubMed

Insights

Antibiotic-induced anaphylaxis is common, especially with penicillin and cephalosporin. Allergy confirmation requires clinical history, skin tests, and drug challenges, not just in vitro tests.

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.

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