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Decoding Beta-Lactam Cross-Reactivity - Longitudinal Patch Testing From 2000 to 2022.
João Nuno Barbosa Soares1,2, André Aparício Martins1, Ana Carolina Figueiredo1
1Dermatology, University Hospital, Coimbra Local Health Unit, Coimbra, Portugal.
Contact Dermatitis
|March 16, 2025
Summary
Patch testing confirms cross-reactivity in non-immediate cutaneous adverse drug reactions to beta-lactam antibiotics. Co-reactivity is common within penicillin and cephalosporin subclasses, but not between the main groups, except for aminopenicillins and aminocephalosporins.
Area of Science:
- Pharmacology
- Dermatology
- Immunology
Background:
- Patients with non-immediate hypersensitivity to beta-lactam (βL) antibiotics often avoid all βL drugs, limiting treatment options.
- Non-immediate cutaneous adverse drug reactions (ni-CADRs) are a significant concern in βL antibiotic use.
Purpose of the Study:
- To evaluate the cross-reactivity patterns among various beta-lactam (βL) antibiotics in patients experiencing non-immediate cutaneous adverse drug reactions (ni-CADRs).
- To determine the utility of patch testing (PT) in identifying specific βL culprits and understanding cross-reactivity in ni-CADRs.
Main Methods:
- Retrospective analysis of 414 patients with suspected ni-CADR to βL antibiotics from 2000-2022.
- Utilized patch testing (PT) with an extended antibiotic series according to European Society of Contact Dermatitis (ESCD) guidelines.
- Statistical analysis included Fisher exact test and odds ratio (OR) with 95% confidence intervals (CI) to assess associations.
Main Results:
- 21% of patients had positive patch test results to at least one drug; 14% reacted to βL antibiotics.
- Co-reactivity was nearly universal within penicillin subclasses and observed between aminopenicillins and aminocephalosporins.
- Cross-reactivity was noted within cephalosporins, and an unexpected association was found between meropenem and ceftriaxone.
Conclusions:
- Patch testing is a valuable tool for diagnosing culprit beta-lactam (βL) antibiotics in non-immediate cutaneous adverse drug reactions (ni-CADRs).
- Significant cross-reactivity exists within penicillin and cephalosporin subclasses, impacting therapeutic choices.
- While generally distinct, an association between aminopenicillins and aminocephalosporins, and an unexpected link between meropenem and ceftriaxone, were identified.
