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Cross-Reactivity among Beta-Lactams.

Antonino Romano1,2, Francesco Gaeta3, Maria Francisca Arribas Poves4

  • 1Allergy Unit, Complesso Integrato Columbus, Via G. Moscati, 31, 00168, Rome, Italy. aromano.allergy@gmail.com.

Current Allergy and Asthma Reports
|February 23, 2016
PubMed
Summary
This summary is machine-generated.

Beta-lactam antibiotic hypersensitivity reactions are common. Cross-reactivity between penicillins and cephalosporins is often linked to similar side chains, while reactions to carbapenems and aztreonam are rare in penicillin-allergic patients.

Keywords:
AztreonamBeta-lactamsCarbapenemsCephalosporinsCross-reactivityHypersensitivityPenicillins

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Area of Science:

  • Immunology
  • Pharmacology
  • Allergy

Background:

  • Beta-lactam (BL) antibiotics, including penicillins and cephalosporins, are widely used but frequently cause drug hypersensitivity reactions.
  • Minor BL classes include monobactams, carbapenems, oxacephems, and beta-lactamase inhibitors.

Purpose of the Study:

  • To review prospective studies evaluating cross-reactivity among different beta-lactam antibiotic classes in patients with confirmed hypersensitivity to a specific BL.
  • To elucidate the role of structural similarities, particularly side chains, in mediating cross-reactivity.

Main Methods:

  • Analysis of prospective studies involving allergy testing with alternative BLs in subjects with documented hypersensitivity to a particular BL class.
  • Administration of alternative BLs to patients with negative allergy test results.

Main Results:

  • Cross-reactivity among BLs, especially between penicillins and cephalosporins, is primarily associated with structural similarities in their side chains.
  • In penicillin-allergic individuals, cross-reactivity with cephalosporins sharing identical side chains can exceed 30%.
  • Cross-reactivity between penicillins and carbapenems or aztreonam is less than 1% in penicillin-allergic subjects.

Conclusions:

  • Hypersensitivity cross-reactivity among beta-lactam antibiotics is largely driven by side-chain determinants.
  • While rare, cross-reactivity involving the core beta-lactam ring or coexisting sensitivities due to prior exposures can occur.