Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis

Antonino Romano, Rocco Luigi Valluzzi, Cristiano Caruso, Michela Maggioletti, Francesco Gaeta

Research output: Contribution to journalReview articlepeer-review


Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.

Original languageEnglish
Article number23
JournalCurrent Allergy and Asthma Reports
Issue number4
Publication statusPublished - Apr 1 2017


  • Beta-lactam allergy
  • Challenges
  • Cross-reactivity
  • Non-immediate reactions
  • Skin tests
  • Tolerability

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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