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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

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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]

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