Side-chain-specific reactions to betalactams: 14 years later

• Published in: Clinical and experimental allergy 2002-02, Vol.32 (2), p.192-197
• Main Authors: Blanca, M., Mayorga, C., Torres, M. J., Warrington, R., Romano, A., Demoly, P., Silviu-Dan, F., Moya, M., Fernandez, J., Juárez, C.
• Format: Article
• Language: English
• Subjects: Allergic diseases; Anti-Bacterial Agents - chemistry; Anti-Bacterial Agents - immunology; Biological and medical sciences; Cross Reactions; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - immunology; Drug Hypersensitivity - physiopathology; Drug toxicity and drugs side effects treatment; Epitopes; Humans; Immunopathology; Lactams - chemistry; Lactams - immunology; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Other localizations; Pharmacology. Drug treatments
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1046/j.1365-2222.2002.01299.x

Fourteen years ago Blanca et al. reported cases where subjects developed anaphylactic responses to amoxicillin (AX) but had good tolerance to the closely related betalactam, benzylpenicillin (BP). These cases were skin test positive only to AX and negative to the major and minor determinants of BP and they had IgE antibodies to the AX but not the benzylpenicilloyl (BPO) determinant. They were therefore diagnosed as having an immediate selective response to AX. These findings were followed by a study in a large group of patients with immediate reactions (IR) to penicillins, in whom 30% of the patients proved selective to AX. Since then a number of studies by different groups have supported the existence of side-chain-specific reactions. At the same time, reports of non-immediate selective reactions to aminopenicillins were also published, so that the concept of side-chain-specific reactions to betalactams was extended to T cell mediated responses. This article analyses the data published over this period by different groups working in different countries.