Decoding Beta-Lactam Cross-Reactivity – Longitudinal Patch Testing From 2000 to 2022

IF 4.6 1区医学 Q2 ALLERGY

Contact Dermatitis Pub Date : 2025-03-16 DOI:10.1111/cod.14767

João Nuno Barbosa Soares, André Aparício Martins, Ana Carolina Figueiredo, André Castro Pinho, Francisco Caramelo, Margarida Gonçalo

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引用次数: 0

Abstract

Introduction

Patients with non-immediate hypersensitivity to beta-lactam antibiotics (βL) often avoid all βL, with limitations for future therapy.

Objectives

Assess cross-reactivity between βL in non-immediate cutaneous adverse drug reactions (ni-CADRs).

Methods

Retrospective analysis (2000–2022) of patients with suspected ni-CADR with βL as a possible culprit who underwent patch testing (PT) with an extended antibiotic series (10% pet., Chemotechnique Diagnostics or prepared in-house) according to European Society of Contact Dermatitis (ESCD) recommendations. Fisher exact test was used with a significance of 0.05 corrected for multiple testing; positive associations were quantified with odds ratio (OR) with 95% confidence interval (CI).

Results

Four hundred and fourteen patients (270 female/144 male; age 52 ± 19 years) were included, mostly with maculopapular exanthema (367; 89%), drug reaction with eosinophilia and systemic symptoms (DRESS) (22; 5%) and acute generalised exanthematous pustulosis (AGEP) (12; 3%). Eighty-six patients (21%) had positive results to at least one drug. Fifty-eight patients (14%) had 110 positive results to βL, mostly amoxicillin (33). Co-reactivity within penicillins was almost universal, including piperacillin with other penicillins (p = 0.007; OR 25; CI 3–56). There was co-reactivity to aminopenicillins and aminocephalosporins (p = 0.006; OR 33; CI 4–74) and within the cephalosporin subclass, including between aminocephalosporins and non-aminocephalosporins. Within carbapenems, 1 patient reacted to meropenem and ertapenem, with no extension to imipenem, as confirmed with a provocation test. Two patients reacted both to ceftriaxone and meropenem (p = 0.013; OR: 68; CI:15–612).

Conclusion

PT is useful to confirm a probable culprit in ni-CADR to βL. Co-reactivity, interpreted mostly as cross-reactivity, occurred within cephalosporin and, particularly, with penicillin subclasses, including between piperacillin-tazobactam and remaining penicillins, which has seldom been described. There was no association between penicillins and cephalosporins as a whole, except between aminopenicillins and aminocephalosporins, attributable to a similar lateral chain amino group. We found an unexpected association between meropenem and ceftriaxone, probably a concomitant sensitization.

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解码β -内酰胺交叉反应性-纵向贴片测试从2000年到2022年。

对β -内酰胺类抗生素（βL）非立即过敏的患者通常避免所有βL，对未来治疗有限制。目的：评估βL在非立即皮肤药物不良反应（ni-CADRs）中的交叉反应性。方法：回顾性分析（2000-2022）以βL为可能罪魁祸首的疑似ni-CADR患者，这些患者接受了延长抗生素系列（10% pet）的贴片试验（PT）。根据欧洲接触性皮炎学会（ESCD）的建议，化学技术诊断或内部准备。采用Fisher精确检验，经多重检验校正，显著性为0.05；用比值比（OR）和95%可信区间（CI）量化正相关。结果：414例患者(女性270例/男性144例；年龄52±19岁)，以黄斑丘疹为主(367例；89%)，药物反应伴嗜酸性粒细胞增多和全身症状（DRESS） (22；5%)和急性全身性脓疱病（AGEP） (12%；3%)。86例患者（21%）对至少一种药物有阳性结果。58例患者(14%)βL 110阳性，主要是阿莫西林（33）。青霉素内的共反应性几乎普遍存在，包括哌拉西林与其他青霉素(p = 0.007；或25;CI 3-56)。对氨霉素和氨头孢菌素有共反应性(p = 0.006；或33;CI 4-74)和在头孢菌素亚类内，包括在氨基头孢菌素和非氨基头孢菌素之间。在碳青霉烯类药物中，经激发试验证实，1例患者对美罗培南和厄他培南有反应，没有扩展到亚胺培南。2例患者对头孢曲松和美罗培南均有反应(p = 0.013；或者:68;置信区间:15 - 612)。结论：PT可用于确定ni-CADR对βL的可能病因。共反应性，主要解释为交叉反应性，发生在头孢菌素内，特别是与青霉素亚类，包括哌拉西林-他唑巴坦和剩余青霉素之间，很少有描述。总的来说，青霉素类和头孢菌素之间没有关联，除了氨霉素类和氨头孢菌素之间存在关联，这可归因于相似的侧链氨基。我们发现美罗培南和头孢曲松之间有一种意想不到的联系，可能是伴随的致敏。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contact Dermatitis 医学-过敏

CiteScore

4.60

自引率

30.90%

发文量

227

审稿时长

4-8 weeks

期刊介绍： Contact Dermatitis is designed primarily as a journal for clinicians who are interested in various aspects of environmental dermatitis. This includes both allergic and irritant (toxic) types of contact dermatitis, occupational (industrial) dermatitis and consumers" dermatitis from such products as cosmetics and toiletries. The journal aims at promoting and maintaining communication among dermatologists, industrial physicians, allergists and clinical immunologists, as well as chemists and research workers involved in industry and the production of consumer goods. Papers are invited on clinical observations, diagnosis and methods of investigation of patients, therapeutic measures, organisation and legislation relating to the control of occupational and consumers".