TY - JOUR
T1 - Non-immediate Cutaneous Reactions to Beta-Lactams
T2 - Approach to Diagnosis
AU - Romano, Antonino
AU - Valluzzi, Rocco Luigi
AU - Caruso, Cristiano
AU - Maggioletti, Michela
AU - Gaeta, Francesco
PY - 2017/4/1
Y1 - 2017/4/1
N2 - 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.
AB - 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.
KW - Beta-lactam allergy
KW - Challenges
KW - Cross-reactivity
KW - Non-immediate reactions
KW - Skin tests
KW - Tolerability
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U2 - 10.1007/s11882-017-0691-4
DO - 10.1007/s11882-017-0691-4
M3 - Review article
C2 - 28382604
AN - SCOPUS:85017207395
VL - 17
JO - Current Allergy and Asthma Reports
JF - Current Allergy and Asthma Reports
SN - 1529-7322
IS - 4
M1 - 23
ER -