Original
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
Gerda Wurpts, Werner Aberer, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Helmut Sitter, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Bettina Wedi, Margitta Worm, und Knut Brockow
Volume 4 (2020) p. 11 - 43
Abstract
Allergologie select, Vol. 4/2020 (11-43)
Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics
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, und Knut Brockow18
1Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany 2Department of Dermatology, Graz Medical University, Graz, Austria, 3Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum, 4Department of Dermatology, University Hospital Münster, Münster, 5Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Gießen Site, Gießen, 6Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale), 7Paul-Ehrlich Institute, Langen, 8Department of Dermatology, University Hospital Erlangen, Erlangen, 9Asthma and Allergy Centre, Leverkusen, 10Division of Pediatric Dermatology and Allergology, Auf der Bult Children’s Hospital, Hannover, 11Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Marburg Site, Marburg, 12Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, 13Institute of Surgical Research, Philipps University Marburg, Marburg, 14Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg, 15Department of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Leipzig, 16Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, 17Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Allergy Center Charité (ACC), Berlin, and 18Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
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.Correspondence to:
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]
Statement
Induction of penicillin tolerance during pregnancy: Allergological opinion on the recommendation of the current AWMF Guidelines on Diagnosis and Treatment of Syphilis (AWMF Registry No. 059-002)
Bettina Wedi, Werner Aberer, Knut Brockow, Heinrich Dickel, Randolf Brehler, Thilo Jakob, Burkhard Kreft, Vera Mahler, Hans F. Merk, Norbert Mülleneisen, Hagen Ott, Wolfgang Pfützner, Stefani Röseler, Franziska Ruëff, Cord Sunderkötter, Axel Trautmann, Regina Treudler, Margitta Worm, and Gerda Wurpts
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Volume 5 (2021) p. 67 - 71
Abstract
Allergologie select, Vol. 5/2021 (67-71)
Induction of penicillin tolerance during pregnancy: Allergological opinion on the recommendation of the current AWMF Guidelines on Diagnosis and Treatment of Syphilis (AWMF Registry No. 059-002)
Bettina Wedi1, Werner Aberer2, Knut Brockow3, Heinrich Dickel4, Randolf Brehler5, Thilo Jakob6, Burkhard Kreft7, Vera Mahler8,9, Hans F. Merk10, Norbert Mülleneisen11, Hagen Ott12, Wolfgang Pfützner13, Stefani Röseler14, Franziska Ruëff15, Cord Sunderkötter16, Axel Trautmann17, Regina Treudler18, Margitta Worm19, and Gerda Wurpts20
1Department of Dermatology, Allergology, and Venereology, Comprehensive Allergy Center, Hannover Medical School, Germany, 2Department of Dermatology, Medical University Graz, Austria, 3Department and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, 4Department of Dermatology, Venereology, and Allergology, St. Josef-Hospital, University Hospital of the Ruhr University of Bochum, 5Department of Dermatology, University Hospital Muenster, 6Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Gießen, 7Department of Dermatology and Venereology, University Hospital Halle (Saale), 8Paul-Ehrlich-Institut, Langen, 9Dermatologists at the Merckhaus Dr. Herbst and Kollegen, Darmstadt, 10Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, 11Lung and Allergy Center, Leverkusen, 12Pediatric Dermatology and Allergology, Children’s and Youth Hospital “Auf der Bult”, Hannover, 13Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Campus Marburg, 14Augustinians Hospital, Academic Teaching Hospital of the University of Cologne, 15Department and Outpatient Clinic of Dermatology, and Allergology, Allergy Center, Hospital of the University of Munich, 16University Hospital and Outpatient Clinic of Dermatogy and Venereology, University Hospital Halle (Saale), 17Department and Outpatient Clinic of Dermatology, Venereology, and Allergology, Allergy Center Mainfranken, University Hospital Würzburg, 18Department and Outpatient Clinic of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Allergy Center – LICACAC, University of Leipzig, 19Department for Dermatology, Venereology, and Allergology, Charité-University Medicine Berlin, Allergy Center-Charité (ACC), Berlin, 20Department of Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), University Hospital RWTH Aachen, Germany
Correspondence to:
Prof. Dr. Bettina Wedi, Klinik für Dermatologie, Allergologie und Venerologie, Comprehensive Allergy Center, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]
Review
Suspected allergy to Beta-Lactam antibiotics: An infectiological perspective
Cord Sunderkötter
Volume 6 (2022) p. 27 - 32
Abstract
Allergologie select, Vol. 6/2022 (27-32)
Suspected allergy to Beta-Lactam antibiotics: An infectiological perspective
Cord Sunderkötter
Department of Dermatology and Venereology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
The administration of alternative broad-spectrum antibiotics because of a suspected allergy to beta-lactam antibiotics (BLA) is one reason for the increase in bacterial resistance to antibiotics and results in further problems, such as reduced efficiency against the causative bacteria, longer hospital stays, higher prices, and more adverse events. Patients with documented BLA allergy experience Clostridium difficile infections and postoperative surgical-site infections more frequently than patients without this label. Yet, in cases of documented and even proven IgE-mediated allergy to a BLA, such as penicillin or cephalosporin, the careful application of a different BLA with dissimilar core and side chains is possible. Cefazolin, e.g., would often be a candidate for skin and soft-tissue infections (e.g., cellulitis) or for perioperative prophylaxis, because it does not share a common side chain with any other BLA and tackles most causative bacteria. In case of severe cellulitis, a carbapenem would be a candidate. After type IV-reactions (benign maculopapular rash), an infectiologist’s choice would be to apply another narrow-spectrum BLA. In cases where a long-lasting therapy with penicillin is indicated (e.g., for late syphilis or prophylaxis of erysipelas) in presence of a proven IgE-mediated allergy, desensitization would be the infectiologist’s choice.Correspondence to:
Prof. Dr. Cord Sunderkötter, Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale)
Email: [email protected]
Case Report
Cefazolin as an alternative in patients with a history of penicillin or β-lactam antibiotic allergy: A case overview
Burkhard Kreft, Johannes Wohlrab, and Cord Sunderkötter
Volume 10 (2026) p. 101 - 106
Abstract
Allergologie select, Vol. 10/2026 (101-106)
Cefazolin as an alternative in patients with a history of penicillin or β-lactam antibiotic allergy: A case overview
Burkhard Kreft, Johannes Wohlrab, and Cord Sunderkötter
Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Germany
Many patients with suspected or confirmed allergy to penicillin or β-lactam antibiotics are unnecessarily denied all β-lactam antibiotics (BLA) and instead given a less effective antibiotic with more side effects. However, cefazolin, a first-generation cephalosporin, is a safe and effective treatment option for these patients in most cases. Recent studies show that immunological cross-reactions among BLAs are primarily caused by structural similarities in the side chains and not by the common β-lactam ring. Cefazolin has unique R1 and R2 side chains that largely rule out cross-reactivity with other BLAs. In a case series, 21 patients with a history of alleged or confirmed allergy to BLAs were exposed to cefazolin under real-life conditions, and all but 1 patient (who developed an uncomplicated maculopapular rash) showed no reaction. Therefore, the use of cefazolin is acceptable under clinical supervision in cases of a previous uncomplicated delayed-type reaction. However, in cases of reported or documented clinical reactions to BLA that are indicative of a type I allergy (such as urticaria, angioedema, anaphylaxis), prior to (titrated) administration of cefazolin under appropriate monitoring measures, a diagnostic evaluation in accordance with guidelines, including a negative skin test for cefazolin, is advisable. This procedure avoids the use of less suitable reserve antibiotics and ensures effective treatment without incalculable risk for anaphylaxis.Correspondence to:
Dr. med. Burkhard Kreft, Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
Email: [email protected]
