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Zavaleta-Monestel E, Webster K, Rojas-Chinchilla C, Muñoz-Gutierrez G, Díaz-Madriz JP. Management and Implications of Beta-Lactam Allergies. Cureus 2024; 16:e60281. [PMID: 38872647 PMCID: PMC11170240 DOI: 10.7759/cureus.60281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Beta-lactam antibiotics are essential components in the current antimicrobial treatment strategy, playing a crucial role in ambulatory patients and hospitalized patients. Despite their prominent therapeutic index, the use of beta-lactam can lead to adverse effects, with allergic reactions being the most concerning because of their severity. Additionally, the phenomenon of cross-reactivity may occur among various beta-lactam families, with side chains significantly contributing to immunological recognition, making these structures often responsible for the cross-allergic reactivity of beta-lactams. Tools to assess beta-lactam allergy include taking a patient's medical history, performing skin tests, and conducting provocation tests. This research aims to analyze the relevant aspects related to the safe administration of beta-lactam antibiotics in hospitalized patients as well as provide knowledge on the proper management of patients with such hypersensitivity, by doing systemic research. This research was made using Google Scholar and keywords such as "Beta-lactam allergy," "Hypersensitivity," "Cross-reactivity," "Desensitization," and "Beta-lactam allergy management." In conclusion, substituting a beta-lactam antibiotic with an alternative antibiotic may not always be the best management option for these patients, as it may lead to more adverse effects, be less effective, and prolong hospitalization time. It may also result in higher rates of antibiotic-resistant infections and increased medical costs, as these alternatives are often more expensive. However, an alternative within the beta-lactam family can be sought by conducting the appropriate analyses. Although cross-reactivity does not always occur among all beta-lactams, potential cross-reactivity should always be considered.
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Affiliation(s)
| | - Keyla Webster
- Pharmacy, Universidad de Ciencias Médicas, San Jose, CRI
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2
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Mayorga C, Montañez MI, Najera F, Bogas G, Fernandez TD, Gil DR, Palacios R, Torres MJ, Vida Y, Perez-Inestrosa E. The Role of Benzylpenicilloyl Epimers in Specific IgE Recognition. Front Pharmacol 2021; 12:585890. [PMID: 33716734 PMCID: PMC7952312 DOI: 10.3389/fphar.2021.585890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
The high prevalence of allergy to β-lactam antibiotics is a worldwide issue. Accuracy of diagnostic methods is important to prove tolerance or allergy, with skin test considered the best validated in vivo method for diagnosing immediate reactions to β-lactams. Although drug provocation test is the reference standard, it cannot be performed in highly risk reactions or in those with positive skin tests. For skin tests, the inclusion of major and minor determinants of benzylpenicillin (BP) is recommended. Commercial skin test reagents have changed along time, including as minor determinants benzylpenicillin, benzylpenicilloate (BPO), and benzylpenilloate (PO). Major determinants consists of multivalent conjugates of benzylpenicilloyl coupled through amide bond to a carrier polymer, such as penicilloyl-polylysine (PPL) or benzylpenicilloyl-octalysine (BP-OL). The chemical stability of such reagents has influenced the evolution of the composition of the commercial kits, as this requirement is necessary for improving the quality and standardization of the product. In this work, we provide a detailed study of the chemical stability of BP determinants. We observed that those structures suffer from an epimerization process in C-5 at different rates. Butylamine-Benzylpenicilloyl conjugates (5R,6R)-Bu-BPO and (5S,6R)-Bu-BPO were selected as a simple model for mayor determinant to evaluate the role of the different epimers in the immunoreactivity with sera from penicillin-allergic patients. In vitro immunoassays indicate that any change in the chemical structure of the antigenic determinant of BP significantly affects IgE recognition. The inclusion of stereochemically pure compounds or mixtures may have important implications for both the reproducibility and sensitivity of in vivo and in vitro diagnostic tests.
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Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Maria I. Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
| | - Francisco Najera
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
| | - Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Tahía D. Fernandez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Universidad de Málaga-IBIMA, Departamento de Biología celular, Genética y Fisiología, Málaga, Spain
| | | | | | - Maria J. Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA, Departamento de Medicina, Málaga, Spain
| | - Yolanda Vida
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
| | - Ezequiel Perez-Inestrosa
- Centro Andaluz de Nanomedicina y Biotecnología-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain
- Universidad de Málaga-IBIMA Departamento de Química Orgánica, Málaga, Spain
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3
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Bogas G, Mayorga C, Martín-Serrano Á, Fernández-Santamaría R, Jiménez-Sánchez IM, Ariza A, Barrionuevo E, Posadas T, Salas M, Fernández TD, Torres MJ, Montañez MI. Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes. Clin Transl Allergy 2020; 10:57. [PMID: 33292516 PMCID: PMC7716594 DOI: 10.1186/s13601-020-00368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. METHODS Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. RESULTS Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. CONCLUSIONS Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients.
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Grants
- PI12/02529, PI15/01206, PI18/00095, RETIC ARADYAL RD16/0006/0001 Instituto de Salud Carlos III
- CP15/00103, PI17/01237 Instituto de Salud Carlos III
- JR18/00054 Instituto de Salud Carlos III
- CD17/0146 Instituto de Salud Carlos III
- CTS-06603 Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía (ES)
- C-0044-2012 SAS2013 Consejería de Salud, Junta de Andalucía
- PI-0699-2011, PI-0179-2014 Consejería de Salud, Junta de Andalucía
- PE-0172-2018 Consejería de Salud, Junta de Andalucía
- PE-0172-2018 Consejería de Salud, Junta de Andalucía
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Affiliation(s)
- Gador Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Ángela Martín-Serrano
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Rubén Fernández-Santamaría
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
| | - Isabel M. Jiménez-Sánchez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
| | - Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
| | - Esther Barrionuevo
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Teresa Posadas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
| | - Tahía Diana Fernández
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29071 Málaga, Spain
| | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, 29071 Málaga, Spain
| | - María Isabel Montañez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, 29009 Málaga, Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain
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Smets I, Verelst S, Meyfroidt G, Van Wijngaerden E, Wilmer A, van Loon J, Lagrou K, Dubois B. Community-acquired bacterial meningitis in adults: emergency department management protocol. Acta Neurol Belg 2020; 120:1033-1043. [PMID: 32666505 DOI: 10.1007/s13760-020-01428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
Acute bacterial meningitis (ABM) is a rare but disabling infectious condition that requires a performant multidisciplinary management approach. Between 70 and 90 adult patients are diagnosed with community-acquired ABM in Belgium annually, and reported case fatality rates range from 17 to 40%. The currently available guidelines provide evidence-based guidance on how to manage this disease. However, these guidelines do not translate the evidence to the daily practice at the emergency department in a Belgian healthcare context. We created a taskforce in University Hospitals Leuven consisting of experts with complementary expertise in managing this disease: neurology, neurosurgery, intensive care medicine, microbiology and infectious diseases. The taskforce agreed upon a flowchart containing seven management steps encompassing all relevant phases in emergency ABM management. In addition to the focus on timely and adequate initiation of antimicrobial treatment, the flowchart and protocol also provide guidance on practical hurdles such as how to assess the safety of performing a lumbar puncture and when to refer patients to the intensive care department. This protocol was implemented in University Hospitals Leuven and fosters inter-disciplinary coordination of ABM care.
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Mayorga C, Montañez MI, Jurado-Escobar R, Gil-Ocaña V, Cornejo-García JA. An Update on the Immunological, Metabolic and Genetic Mechanisms in Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3813-3828. [PMID: 31692430 DOI: 10.2174/1381612825666191105122414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
Abstract
Drug hypersensitivity reactions (DHRs) represent a major burden on the healthcare system since their diagnostic and management are complex. As they can be influenced by individual genetic background, it is conceivable that the identification of variants in genes potentially involved could be used in genetic testing for the prevention of adverse effects during drug administration. Most genetic studies on severe DHRs have documented HLA alleles as risk factors and some mechanistic models support these associations, which try to shed light on the interaction between drugs and the immune system during lymphocyte presentation. In this sense, drugs are small molecules that behave as haptens, and currently three hypotheses try to explain how they interact with the immune system to induce DHRs: the hapten hypothesis, the direct pharmacological interaction of drugs with immune receptors hypothesis (p-i concept), and the altered self-peptide repertoire hypothesis. The interaction will depend on the nature of the drug and its reactivity, the metabolites generated and the specific HLA alleles. However, there is still a need of a better understanding of the different aspects related to the immunological mechanism, the drug determinants that are finally presented as well as the genetic factors for increasing the risk of suffering DHRs. Most available information on the predictive capacity of genetic testing refers to abacavir hypersensitivity and anticonvulsants-induced severe cutaneous reactions. Better understanding of the underlying mechanisms of DHRs will help us to identify the drugs likely to induce DHRs and to manage patients at risk.
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Affiliation(s)
- Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL. Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain
| | - Maria I Montañez
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain
| | - Raquel Jurado-Escobar
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain.,Universidad de Málaga, Málaga, Spain
| | - Violeta Gil-Ocaña
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND. Malaga, Spain.,Department of Organic Chemistry, Universidad de Málaga, ARADyAL, Málaga, Spain
| | - Jose A Cornejo-García
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA-ARADyAL. Malaga, Spain
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6
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Khosravi M, Boroun F, Nemati M. The anti-penicillin antibodies levels in sensitive and insensitive people to intradermal skin test. Hum Antibodies 2018; 27:63-68. [PMID: 30223394 DOI: 10.3233/hab-180349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The hypersensitivity reaction to penicillin is a public health problem. Immunological responses to penicillin and other beta-lactam antibiotics can be classified into immediate and non-immediate responses. The immediate hypersensitivity is mediated by IgE; however, the non-immediate sensitivity is facilitated by other isotypes of antibody or T lymphocytes. OBJECTIVE This research detected the non-IgE antibody value against penicillin in allergic and normal people. METHODS Thirty-eight samples from patients with positive or negative intradermal skin testing results of penicillin allergy were included in this study. The total antibody and IgM levels against penicillin G were defined by in-house ELISA test. RESULTS The results showed a significant (P< 0.05) elevation in total immunoglobulin and non-IgM anti-penicillin antibody of sensitive groups; however, the anti-penicillin IgM was significantly greater in non-sensitive peoples. CONCLUSIONS Although the sensitized people to penicillin cannot be certainly detected with the total antibody, specific IgG and IgM value against penicillin, these values are good indicators for prediction of immediate and late response of the immune system to penicillin.
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Affiliation(s)
- Mohammad Khosravi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Fatemeh Boroun
- Graduated Student of Microbiology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Mohammad Nemati
- Department of Venomous Animals and Toxins, Razi Vaccine and Serum Research Institute, Ahvaz Branch, Agriculture Research Education and Extension Organization (AREEO), Iran
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7
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Molina N, Martin-Serrano A, Fernandez TD, Tesfaye A, Najera F, Torres MJ, Mayorga C, Vida Y, Montañez MI, Perez-Inestrosa E. Dendrimeric Antigens for Drug Allergy Diagnosis: A New Approach for Basophil Activation Tests. Molecules 2018; 23:E997. [PMID: 29695102 PMCID: PMC6100007 DOI: 10.3390/molecules23050997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 12/03/2022] Open
Abstract
Dendrimeric Antigens (DeAns) consist of dendrimers decorated with multiple units of drug antigenic determinants. These conjugates have been shown to be a powerful tool for diagnosing penicillin allergy using in vitro immunoassays, in which they are recognized by specific IgE from allergic patients. Here we propose a new diagnostic approach using DeAns in cellular tests, in which recognition occurs through IgE bound to the basophil surface. Both IgE molecular recognition and subsequent cell activation may be influenced by the tridimensional architecture and size of the immunogens. Structural features of benzylpenicilloyl-DeAn and amoxicilloyl-DeAn (G2 and G4 PAMAM) were studied by diffusion Nuclear Magnetic Resonance (NMR) experiments and are discussed in relation to molecular dynamics simulation (MDS) observations. IgE recognition was clinically evaluated using the basophil activation test (BAT) for allergic patients and tolerant subjects. Diffusion NMR experiments, MDS and cellular studies provide evidence that the size of the DeAn, its antigen composition and tridimensional distribution play key roles in IgE-antigen recognition at the effector cell surface. These results indicate that the fourth generation DeAns induce a higher level of basophil activation in allergic patients. This approach can be considered as a potential complementary diagnostic method for evaluating penicillin allergy.
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Affiliation(s)
- Noemi Molina
- Departamento de Química Orgánica, Universidad de Málaga-IBIMA, 29071 Málaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
| | - Angela Martin-Serrano
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Tahia D Fernandez
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Amene Tesfaye
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Francisco Najera
- Departamento de Química Orgánica, Universidad de Málaga-IBIMA, 29071 Málaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
| | - María J Torres
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Cristobalina Mayorga
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
- Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Yolanda Vida
- Departamento de Química Orgánica, Universidad de Málaga-IBIMA, 29071 Málaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
| | - Maria I Montañez
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
- Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, 29009 Málaga, Spain.
| | - Ezequiel Perez-Inestrosa
- Departamento de Química Orgánica, Universidad de Málaga-IBIMA, 29071 Málaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, 29590 Málaga, Spain.
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8
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How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Hisham M, Sivakumar MN, Senthil Kumar RS, Nandakumar P. Ludwig's Angina: A Nightmare Worsened by Adverse Drug Reaction to Antibiotics. Indian J Crit Care Med 2017; 21:179-181. [PMID: 28400693 PMCID: PMC5363111 DOI: 10.4103/ijccm.ijccm_189_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig's angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole. The patient improved and was discharged after five days of ICU stay and 12 days of hospitalization. This case summarizes the rare incidence of Ludwig's angina with antibiotic adverse reactions. If angioneurotic edema is coincidental with features of Ludwig's angina, it becomes more challenging. Early identification, securing the airway, and antibiotic administration are the keystone to better survival.
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Affiliation(s)
- Mohamed Hisham
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | | | - R S Senthil Kumar
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - P Nandakumar
- Department of Critical Care Medicine, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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10
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Ariza A, Mayorga C, Salas M, Doña I, Martín-Serrano Á, Pérez-Inestrosa E, Pérez-Sala D, Guzmán AE, Montañez MI, Torres MJ. The influence of the carrier molecule on amoxicillin recognition by specific IgE in patients with immediate hypersensitivity reactions to betalactams. Sci Rep 2016; 6:35113. [PMID: 27731424 PMCID: PMC5059705 DOI: 10.1038/srep35113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022] Open
Abstract
The optimal recognition of penicillin determinants, including amoxicillin (AX), by specific IgE antibodies is widely believed to require covalent binding to a carrier molecule. The nature of the carrier and its contribution to the antigenic determinant is not well known. Here we aimed to evaluate the specific-IgE recognition of different AX-derived structures. We studied patients with immediate hypersensitivity reactions to AX, classified as selective or cross-reactors to penicillins. Competitive immunoassays were performed using AX itself, amoxicilloic acid, AX bound to butylamine (AXO-BA) or to human serum albumin (AXO-HSA) in the fluid phase, as inhibitors, and amoxicilloyl-poli-L-lysine (AXO-PLL) in the solid-phase. Two distinct patterns of AX recognition by IgE were found: Group A showed a higher recognition of AX itself and AX-modified components of low molecular weights, whilst Group B showed similar recognition of both unconjugated and conjugated AX. Amoxicilloic acid was poorly recognized in both groups, which reinforces the need for AX conjugation to a carrier for optimal recognition. Remarkably, IgE recognition in Group A (selective responders to AX) is influenced by the mode of binding and/or the nature of the carrier; whereas IgE in Group B (cross-responders to penicillins) recognizes AX independently of the nature of the carrier.
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Affiliation(s)
- Adriana Ariza
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Cristobalina Mayorga
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - María Salas
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
| | - Ángela Martín-Serrano
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - Ezequiel Pérez-Inestrosa
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
- Department of Organic Chemistry, University of Málaga, IBIMA, Málaga, Spain
| | | | - Antonio E. Guzmán
- Pharmacy Unit, Regional University Hospital of Malaga, Málaga, Spain
| | - María I. Montañez
- Research Laboratory, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - María J. Torres
- Allergy Unit, IBIMA–Regional University Hospital of Malaga–UMA, Málaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
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Torres MJ, Montañez MI, Ariza A, Salas M, Fernandez TD, Barbero N, Mayorga C, Blanca M. The role of IgE recognition in allergic reactions to amoxicillin and clavulanic acid. Clin Exp Allergy 2016; 46:264-74. [DOI: 10.1111/cea.12689] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M. J. Torres
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. I. Montañez
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
- BIONAND-Andalusian Centre for Nanomedicine and Biotechnology; Malaga Spain
| | - A. Ariza
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. Salas
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - T. D. Fernandez
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - N. Barbero
- BIONAND-Andalusian Centre for Nanomedicine and Biotechnology; Malaga Spain
- Department of Organic Chemistry; IBIMA; University of Malaga; Malaga Spain
| | - C. Mayorga
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
- Research Laboratory; IBIMA-Regional University Hospital of Malaga; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA-Regional University Hospital of Malaga; Malaga Spain
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