Abstract

This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach – even in cases where the need to administer a BLA is acute – is guided by patient history and risk – benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.

Author Details

Authors

• Gerda Wurpts¹
• Werner Aberer²
• Heinrich Dickel³
• Randolf Brehler⁴
• Thilo Jakob⁵
• Burkhard Kreft⁶
• Vera Mahler⁷,⁸
• Hans F. Merk¹
• Norbert Mülleneisen⁹
• Hagen Ott¹⁰
• Wolfgang Pfützner¹¹
• Stefani Röseler¹
• Franziska Ruëff¹²
• Helmut Sitter¹³
• Cord Sunderkötter⁶
• Axel Trautmann¹⁴
• Regina Treudler¹⁵
• Bettina Wedi¹⁶
• Margitta Worm¹⁷
• Knut Brockow¹⁸

Departments

• ¹ Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany
• ² Department of Dermatology, Graz Medical University, Graz, Austria,
• ³ Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum,
• ⁴ Department of Dermatology, University Hospital Münster, Münster,
• ⁵ Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Gießen Site, Gießen,
• ⁶ Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale),
• ⁷ Paul-Ehrlich Institute, Langen,
• ⁸ Department of Dermatology, University Hospital Erlangen, Erlangen,
• ⁹ Asthma and Allergy Centre, Leverkusen,
• ¹ 
• ⁰ Division of Pediatric Dermatology and Allergology, Auf der Bult Children’s Hospital, Hannover,
• ¹ 
• ¹ Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Marburg Site, Marburg,
• ¹ 
• ² Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich,
• ¹ 
• ³ Institute of Surgical Research, Philipps University Marburg, Marburg,
• ¹ 
• ⁴ Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg,
• ¹ 
• ⁵ Department of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Leipzig,
• ¹ 
• ⁶ Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover,
• ¹ 
• ⁷ Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Allergy Center Charité (ACC), Berlin, and
• ¹ 
• ⁸ Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany

Address

Dr. med. Gerda Wurpts, Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
Email: [email protected]

Citation