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Diagnosis and Selection of Alternative Antibiotics in Beta-Lactams Hypersensitivity Reactions: Current Recommendations and Challenges Publisher Pubmed



Kanannejad Z1 ; Pourvali A2 ; Esmaeilzadeh H1, 3 ; Shokouhi Shoormasti R4, 5 ; Reza Fazlollahi M4, 5 ; Fallahpour M6 ; Zaremehrjardi F7
Authors
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Authors Affiliations
  1. 1. Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2. Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
  3. 3. Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz, Iran
  4. 4. Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical, Sciences, Tehran, Iran
  6. 6. Department of Allergy and Clinical Immunology, Rasoole- Akaram Medical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Science, Tehran, Iran
  7. 7. Allergist and Clinical Immunologist, Clinical Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Iran

Source: International Immunopharmacology Published:2023


Abstract

Beta-lactam (BLM) antibiotics, including amino-penicillin and cephalosporins, are typically the first-choice treatment for bacterial infections. However, adverse reactions to these antibiotics are frequently reported, causing non-allergist physicians to select alternative broad-spectrum antibiotics that can have harmful consequences. Patients with unclear histories of hypersensitivity reactions to BLMs should undergo an allergy workup to establish a firm diagnosis, particularly when different drugs are prescribed simultaneously. However, finding the safest, most precise, and cost-effective methods for confirming BLMs hypersensitivity and selecting the most appropriate alternative BLM is uncertain, particularly in severe delayed reactions. This review aims to provide data and recommendations on the availability and validity of skin tests (STs), drug provocation test (DPT) protocols, based on the latest published literature and guideline. To make the process more practical, we focused on cross-reactivity between BLMs and diagnostic tests. There are two main novel aspects of this document: 1) For T-cell-mediated reactions, patient stratification into high, moderate, and low-risk groups based on the mortality and morbidity of adverse drug reactions. 2) For IgE-mediated reactions, stratification of individuals with isolated limited urticarial without anaphylaxis in a low-risk group and removal of the extensive limitation. © 2023 Elsevier B.V.