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Flucloxacillin Hypersensitivity: Patient Outcomes in a Multicenter Retrospective Study
Lucinda Kennard1, Krzysztof Rutkowski2, Leonard Q C Siew2
1Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
The Journal of Allergy and Clinical Immunology. in Practice
|March 30, 2019
Summary
Immediate hypersensitivity reactions to flucloxacillin are more common than delayed reactions. Drug provocation testing is the gold standard for diagnosing flucloxacillin hypersensitivity.
Area of Science:
- Clinical immunology
- Pharmacology
- Dermatology
Background:
- Flucloxacillin is a penicillin antibiotic.
- Hypersensitivity reactions to flucloxacillin can be immediate (IgE-mediated) or nonimmediate (T-cell-mediated).
- Understanding these reactions is crucial for patient safety and effective treatment.
Purpose of the Study:
- To clinically characterize patients with suspected flucloxacillin hypersensitivity.
- To evaluate diagnostic methods for flucloxacillin hypersensitivity.
- To assess cross-reactivity with other penicillins.
Main Methods:
- Retrospective analysis of 108 patients across 4 UK centers.
- Skin testing (prick and intradermal) with flucloxacillin and other penicillins.
- Oral drug provocation testing for skin test-negative patients.
Main Results:
- 37% of patients were diagnosed with flucloxacillin hypersensitivity (33 immediate, 7 nonimmediate).
- Immediate reactions were often severe (58%).
- Intradermal testing showed higher negative predictive value in immediate reactions; cross-sensitization varied by reaction type.
Conclusions:
- Immediate hypersensitivity to flucloxacillin is more frequent than delayed reactions.
- Cross-sensitization to other penicillins is more common in delayed reactions.
- Drug provocation testing is the definitive diagnostic method.
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