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Delayed hypersensitivity to beta-lactams

C López Serrano1, F Villas, R Cabañas

  • 1Allergy Unit, Hospital La Paz, Madrid, Spain.

Journal of Investigational Allergology & Clinical Immunology
|November 1, 1994
PubMed
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Delayed allergic reactions to beta-lactam antibiotics can occur through various immune mechanisms. This study investigated nine patients, identifying type IV hypersensitivity to ampicillin and benzylpenicillin, and Arthus-type reactions.

Area of Science:

  • Immunology
  • Pharmacology
  • Dermatology

Background:

  • Beta-lactam antibiotics are widely used but can cause hypersensitivity reactions.
  • Delayed reactions are less understood than immediate reactions.
  • Distinguishing between different hypersensitivity mechanisms is crucial for patient management.

Purpose of the Study:

  • To investigate the immunological mechanisms underlying delayed allergic reactions to beta-lactam antibiotics.
  • To differentiate between type IV hypersensitivity and other reaction types in patients experiencing delayed reactions.
  • To identify specific determinants responsible for these reactions.

Main Methods:

  • Case series of nine patients with delayed reactions to beta-lactams.
  • Diagnostic evaluations included intradermal skin tests and patch tests.

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  • Clinical challenge tests were performed.
  • Serological tests for specific IgE were conducted.

    • Main Results:

    • Four patients exhibited delayed reactions to ampicillin, with positive intradermal and patch tests, suggesting type IV hypersensitivity to the side chain.
    • These patients tolerated benzylpenicillin, indicating side-chain specificity.
    • Three patients had delayed hypersensitivity reactions to benzylpenicillin.
    • Two patients experienced Arthus-type reactions.
    • Specific IgE antibodies were detected in four patients, though their direct role was uncertain.

    Conclusions:

    • Delayed allergic reactions to beta-lactams can be mediated by type IV hypersensitivity, potentially specific to the antibiotic's side chain.
    • Arthus-type reactions are also implicated in some delayed responses.
    • Further investigation is needed to clarify the role of specific IgE in these delayed reactions.