Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Clin Rev Allergy Immunol. 2022 Jun;62(3):449-462. doi: 10.1007/s12016-021-08903-z. Epub 2021 Nov 12.
Beta-lactam antibiotics are the most commonly reported drug allergy in adults and children. More than 95% of those with reported allergy labels to beta lactams are not confirmed when subjected to allergy testing. Beta lactam antibiotics are associated with a wide spectrum of immediate and delayed drug hypersensitivity reactions. The latency period to symptoms and clinical presentation aids in the causality assessment. Risk stratification based on diagnosis and timing then allows for appropriate management and evaluation. Skin prick testing, intradermal testing and oral challenge are well established for evaluation of immediate reactions. Delayed intradermal testing, patch testing and oral challenge can also be considered for evaluation of mild to moderate delayed reactions. Cross-reactivity between beta-lactams appears to be driven most commonly by a shared R1 side-chain. Standardized algorithms, protocols and pathways are needed for widespread implementation of a pragmatic and effective approach to patients reporting beta lactam allergy.
β-内酰胺类抗生素是成人和儿童最常报告的药物过敏。超过 95%的报告有β-内酰胺类抗生素过敏标签的患者在接受过敏测试时并未得到证实。β-内酰胺类抗生素与广泛的即刻和迟发性药物超敏反应有关。症状和临床表现的潜伏期有助于因果关系评估。基于诊断和时间的风险分层可实现适当的管理和评估。皮肤点刺试验、皮内试验和口服激发试验已被广泛用于评估即刻反应。迟发性皮内试验、斑贴试验和口服激发试验也可用于评估轻度至中度迟发性反应。β-内酰胺类抗生素之间的交叉反应似乎主要由共同的 R1 侧链驱动。需要标准化算法、方案和途径，以便广泛实施一种实用且有效的方法来治疗报告有β-内酰胺类抗生素过敏的患者。
