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  Authority of Polish Society of Allergology

vol 11. no 4. December 2006  

 Postgraduate education
Allergy to antibiotics. Safe antibiotic treatment in patients with confirmed and non-confirmed allergy to beta-lactam antibiotics

Hypersensitivity reactions represent about one third of adverse drug reactions which affect 10-20% of the hospitalized patients and more than 7% of the general population. True allergic reactions to antibiotics account for only a small proportion of the cases reported. However, severe reactions including anaphylaxis, Stevens-Johnson and Leyll syndromes are associated with significant morbidity and mortality. Penicillin allergy is considerably over-diagnosed, which leads to unreasonable restrictions on the use of other beta-lactams. Although the clinical features of allergy to antibiotics and sulfonamides are variable, the skin is most commonly involved. Amoxicillin, ampicillin, and trimetoprim-sulfametoxazole are the most commonly implicated agents. Patients with cystic fibrosis and HIV or mononucleosis infections have a higher risk of allergy. For instance, antigenic determinants have been well identified for penicillin only. This justifies the use of skin testing and in vitro tests to detect specific IgE antibodies. Other tests (e.g. delayed-reading intradermal test, patch tests, lymphocyte transformation test) might be useful to detect delayed sensitization to amino-penicillin. Skin testing with other antibiotics should be informative when considered as a challenge in the skin only. In case of negative allergologic tests, consideration should be given to provocation test with the suspect agent administrated carefully. Different desensitization schedules with penicillin or sulfonamides are proposed in patients with cystic fibrosis and AIDS. This is not recommended when the patients can be correctly diagnosed and an alternative beta-lactam antibiotic may be found.

keywords: antybiotyki, nadwrażliwość, objawy, beta-laktamy, reakcje natychmiastowe i opóźnione, reaktywność krzyżowa, testy laboratoryjne, podawanie w warunkach kontrolowanych, antibiotics, hypersensitivity, symptoms, beta-lactams, immediate and delayed reactions,

pages: from 175 to 187

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