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Fernandez J, Jimenez-Rodriguez TW, Blanca-Lopez N. Classifying cephalosporins: from generation to cross-reactivity. Curr Opin Allergy Clin Immunol 2021; 21:346-354. [PMID: 34074874 DOI: 10.1097/aci.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To review the most recent literature studying the classifications, immunochemistry, and crossreactivity of allergy reactions to cephalosporins. RECENT FINDINGS Over the last five years, research interest has focused on three areas related to cephalosporin allergy: cross-reactivity among cephalosporins and with other beta-lactams; the incidence of adverse reactions in penicillin allergy patients or in reported penicillin allergy labels; and new cephalosporins structures involved in the immunological recognition. SUMMARY Meta-analysis of a substantial number of studies shows that cephalosporins are safer than previously thought. Evidence supports two main conclusions in that regard. First, there is a relatively low percentage of cross-reactivity between cephalosporins and other beta-lactams with penicillins in penicillin allergy patients. Second, there is a very low incidence of allergy reactions in nonselected as well as in selected penicillin allergy patients when cephalosporins are used prior to surgical intervention.On the other hand, few structures have been discovered related to the immune mechanism of cephalosporin allergy reactions, and these are far from being ready to use in clinical practice.
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Affiliation(s)
- Javier Fernandez
- Allergy Section, Alicante General University Hospital, ISABIAL-UMH, Alicante
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Martin‐Serrano A, Perez‐Inestrosa E, Mayorga C, Torres MJ, Montañez MI. Recent patents in allergy and immunology: New pyrazinones for the diagnosis of allergies to aminocephalosporins. Allergy 2021; 76:1288-1291. [PMID: 33247441 DOI: 10.1111/all.14673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Angela Martin‐Serrano
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
| | - Ezequiel Perez‐Inestrosa
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Departamento de Quımica Organica Universidad de Malaga‐IBIMA Málaga Spain
| | - Cristobalina Mayorga
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga Málaga Spain
| | - María José Torres
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND Málaga Spain
- Allergy Unit Hospital Regional Universitario de Málaga Málaga Spain
- Departamento de Medicina Facultad de Medicina Universidad de Málaga Málaga Spain
| | - Maria Isabel Montañez
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory Andalusian Center for Nanomedicine and Biotechnology‐BIONAND 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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Rineh A, Soren O, McEwan T, Ravikumar V, Poh WH, Azamifar F, Naimi-Jamal MR, Cheung CY, Elliott AG, Zuegg J, Blaskovich MAT, Cooper MA, Dolange V, Christodoulides M, Cook GM, Rice SA, Faust SN, Webb JS, Kelso MJ. Discovery of Cephalosporin-3'-Diazeniumdiolates That Show Dual Antibacterial and Antibiofilm Effects against Pseudomonas aeruginosa Clinical Cystic Fibrosis Isolates and Efficacy in a Murine Respiratory Infection Model. ACS Infect Dis 2020; 6:1460-1479. [PMID: 32329596 DOI: 10.1021/acsinfecdis.0c00070] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The formation of biofilms provides a formidable defense for many bacteria against antibiotics and host immune responses. As a consequence, biofilms are thought to be the root cause of most chronic infections, including those occurring on medical indwelling devices, endocarditis, urinary tract infections, diabetic and burn wounds, and bone and joint infections. In cystic fibrosis (CF), chronic Pseudomonas aeruginosa (P. aeruginosa) respiratory infections are the leading cause of morbidity and mortality in adults. Previous studies have shown that many bacteria can undergo a coordinated dispersal event in the presence of low concentrations of nitric oxide (NO), suggesting that NO could be used to initiate biofilm dispersal in chronic infections, enabling clearance of the more vulnerable planktonic cells. In this study, we describe efforts to create "all-in-one" cephalosporin-based NO donor prodrugs (cephalosporin-3'-diazeniumdiolates, C3Ds) that show both direct β-lactam mediated antibacterial activity and antibiofilm effects. Twelve novel C3Ds were synthesized and screened against a panel of P. aeruginosa CF clinical isolates and other human pathogens. The most active compound, AMINOPIP2 ((Z)-1-(4-(2-aminoethyl)piperidin-1-yl)-2-(((6R,7R)-7-((Z)-2-(2-aminothiazol-4-yl)-2-(((2-carboxypropan-2-yl)oxy)imino)acetamido)-2-carboxy-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-en-3-yl)methoxy)diazene 1-oxide)-ceftazidime 12, showed higher antibacterial potency than its parent cephalosporin and front-line antipseudomonal antibiotic ceftazidime, good stability against β-lactamases, activity against ceftazidime-resistant P. aeruginosa in vitro biofilms, and efficacy equivalent to ceftazidime in a murine P. aeruginosa respiratory infection model. The results support further evaluation of AMINOPIP2-ceftazidime 12 for P. aeruginosa lung infections in CF and a broader study of "all-in-one" C3Ds for other chronic infections.
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Affiliation(s)
- Ardeshir Rineh
- Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2522, Australia
| | - Odel Soren
- Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
- National Biofilm Innovation Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Timothy McEwan
- Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2522, Australia
| | - Vikashini Ravikumar
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, 637551, Singapore
| | - Wee Han Poh
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, 637551, Singapore
| | - Fereshteh Azamifar
- Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales 2522, Australia
- Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - M. Reza Naimi-Jamal
- Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Chen-Yi Cheung
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand
| | - Alysha G. Elliott
- Community for Open Antimicrobial Drug Discovery, Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Johannes Zuegg
- Community for Open Antimicrobial Drug Discovery, Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Mark A. T. Blaskovich
- Community for Open Antimicrobial Drug Discovery, Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matthew A. Cooper
- Community for Open Antimicrobial Drug Discovery, Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Victoria Dolange
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Myron Christodoulides
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Gregory M. Cook
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin 9054, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland 1042, New Zealand
| | - Scott A. Rice
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, 637551, Singapore
- ithree Institute, University of Technology Sydney, Ultimo, New South Wales 2007, Australia
- School of Biological Sciences, Nanyang Technological University, 637551, Singapore
| | - Saul N. Faust
- National Biofilm Innovation Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre and NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Jeremy S. Webb
- Biological Sciences and Institute for Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
- National Biofilm Innovation Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
- NIHR Southampton Biomedical Research Centre and NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Michael J. Kelso
- Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2522, Australia
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5
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Montañez MI, Martín-Serrano A, Mayorga C, Barrionuevo E, Pérez N, Romano A, Moreno E, Ariza A, Pérez-Inestrosa E, Torres MJ. Reply. J Allergy Clin Immunol 2020; 146:460-461. [PMID: 32362530 DOI: 10.1016/j.jaci.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Maria I Montañez
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.
| | - Angela Martín-Serrano
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Cristobalina Mayorga
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Natalia Pérez
- Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy; Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Esther Moreno
- Allergy Unit, Salamanca University Hospital-IBSAL, Salamanca, Spain
| | - Adriana Ariza
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Ezequiel Pérez-Inestrosa
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Department of Organic Chemistry, University of Málaga, Málaga, Spain; Biomimetic Dendrimers and Photonic Laboratory, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Maria J Torres
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain; Departamento de Medicina, Universidad de Málaga, Málaga, Spain
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6
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Cephalosporins' Cross-Reactivity and the High Degree of Required Knowledge. Case Report and Review of the Literature. Antibiotics (Basel) 2020; 9:antibiotics9050209. [PMID: 32344946 PMCID: PMC7277108 DOI: 10.3390/antibiotics9050209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022] Open
Abstract
Antibiotic cross-reactivity represents a phenomenon of considerable interest as well as antibiotic resistance. Immediate reactions to cephalosporins are reported in the literature with a prevalence of only 1%-3% of the population, while anaphylactic reactions are rarely described (approximately 0.0001%-0.1%) as well as fatalities. Allergic reaction to cephalosporins may occur because of sensitization to unique cephalosporin haptens or to determinants shared with penicillins. Cross-reactivity between cephalosporins represents, in fact, a well-known threatening event involving cephalosporins with similar or identical R1- or R2-side chains. The present report describes the case of a 79-year-old man who suddenly died after intramuscular administration of ceftriaxone. Serum dosage of mast cell tryptase from a femoral blood sample at 3 and 24 hours detected values of 87.7μg/L and 93.5μg/L, respectively (cut-off value 44.3 μg/L); the serum-specific IgE for penicillins, amoxicillin, cephaclor and also for the most common allergens were also determined. A complete post-mortem examination was performed, including gross, histological and immunohistochemical examination, with an anti-tryptase antibody. The cause of death was identified as anaphylactic shock: past administrations of cefepime sensitized the subject to cephalosporins and a fatal cross-reactivity of ceftriaxone with cefepime occurred due to the identical seven-position side chain structure in both molecules. The reported case offers food for thought regarding the study of cross-reactivity and the need to clarify the predictability and preventability of the phenomenon in fatal events.
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7
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Design of an antigenic determinant of cefaclor: Chemical structure–IgE recognition relationship. J Allergy Clin Immunol 2020; 145:1301-1304.e4. [DOI: 10.1016/j.jaci.2019.11.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 01/24/2023]
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8
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Peña-Mendizabal E, Morais S, Maquieira Á. Boosting the sensitivity of in vitro β-lactam allergy diagnostic tests. Chem Commun (Camb) 2020; 56:11973-11976. [DOI: 10.1039/d0cc04903d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The synthesis of structurally new haptens and the development of suitable antigens are essential for boosting the sensitivity of drug allergy diagnostic testing.
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Affiliation(s)
- Edurne Peña-Mendizabal
- IDM, Universitat Politècnica de València-Universitat de València, Camino de Vera s/n
- 46022 Valencia
- Spain
| | - Sergi Morais
- IDM, Universitat Politècnica de València-Universitat de València, Camino de Vera s/n
- 46022 Valencia
- Spain
- Departamento de Química
- Universitat Politècnica de València
| | - Ángel Maquieira
- IDM, Universitat Politècnica de València-Universitat de València, Camino de Vera s/n
- 46022 Valencia
- Spain
- Departamento de Química
- Universitat Politècnica de València
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9
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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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10
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Cross-reactivity in IgE-mediated allergy to cefuroxime: Focus on the R1 side chain. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1094-1096.e1. [PMID: 31479769 DOI: 10.1016/j.jaip.2019.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022]
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11
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Barbero N, Fernández‐Santamaría R, Mayorga C, Martin‐Serrano Á, Salas M, Bogas G, Nájera F, Pérez‐Sala D, Pérez‐Inestrosa E, Fernandez TD, Montañez MI, Torres MJ. Identification of an antigenic determinant of clavulanic acid responsible for IgE-mediated reactions. Allergy 2019; 74:1490-1501. [PMID: 30829415 DOI: 10.1111/all.13761] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Selective reactions to clavulanic acid (CLV) account for around 30% of immediate reactions after administration of amoxicillin-CLV. Currently, no immunoassay is available for detecting specific IgE to CLV, and its specific recognition in patients with immediate reactions has only been demonstrated by basophil activation testing, however with suboptimal sensitivity. The lack of knowledge regarding the structure of the drug that remains bound to proteins (antigenic determinant) is hampering the development of in vitro diagnostics. We aimed to identify the antigenic determinants of CLV as well as to evaluate their specific IgE recognition and potential role for diagnosis. METHODS Based on complex CLV degradation mechanisms, we hypothesized the formation of two antigenic determinants for CLV, AD-I (N-protein, 3-oxopropanamide) and AD-II (N-protein, 3-aminopropanamide), and designed different synthetic analogs to each one. IgE recognition of these structures was evaluated in basophils from patients with selective reactions to CLV and tolerant subjects. In parallel, the CLV fragments bound to proteins were identified by proteomic approaches. RESULTS Two synthetic analogs of AD-I were found to activate basophils from allergic patients. This determinant was also detected bound to lysines 195 and 475 of CLV-treated human serum albumin. One of these analogs was able to activate basophils in 59% of patients whereas CLV only in 41%. Combining both results led to an increase in basophil activation in 69% of patients, and only in 12% of controls. CONCLUSION We have identified AD-I as one CLV antigenic determinant, which is the drug fragment that remains protein-bound.
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Affiliation(s)
- Nekane Barbero
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Department of Organic Chemistry IBIMAUniversity of Málaga Málaga Spain
| | | | - Cristobalina Mayorga
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
- Allergy UnitHospital Regional Universitario de Malaga Málaga Spain
| | - Ángela Martin‐Serrano
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
| | - María Salas
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
- Allergy UnitHospital Regional Universitario de Malaga Málaga Spain
| | - Gador Bogas
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
- Allergy UnitHospital Regional Universitario de Malaga Málaga Spain
| | - Francisco Nájera
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Department of Organic Chemistry IBIMAUniversity of Málaga Málaga Spain
| | | | - Ezequiel Pérez‐Inestrosa
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Department of Organic Chemistry IBIMAUniversity of Málaga Málaga Spain
| | - Tahia D. Fernandez
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
| | - María I. Montañez
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
| | - María J. Torres
- Andalusian Center for Nanomedicine and Biotechnology – BIONANDMálaga Spain
- Allergy Research GroupInstituto de Investigacion Biomédica de Malaga‐IBIMA Málaga Spain
- Allergy UnitHospital Regional Universitario de Malaga Málaga Spain
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Zagursky RJ, Pichichero ME. Cross-reactivity in β-Lactam Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:72-81.e1. [PMID: 29017833 DOI: 10.1016/j.jaip.2017.08.027] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 01/13/2023]
Abstract
β-Lactam drugs (penicillins, amoxicillin, and cephalosporins) account for 42.6% of all severe drug-induced anaphylaxis. In this review, we focus on clinically significant immunologic cross-reactivity in patients with confirmed penicillin allergy to cephalosporins, and the structural involvement of the R1 and R2 chemical side chains of the cephalosporins causing IgE-mediated cross-reactivity with penicillin and other cephalosporins. Skin tests predict IgE-mediated reactions and showed cross-reactivity between penicillins and early generation cephalosporins that shared side chains, but confirmatory challenge data are lacking. Later-generation cephalosporins, which have distinct side chains, do not have any skin test cross-reactivity with penicillin/amoxicillin. There is debate as to the involvement of R2 side chains as the antigenic determinants that cause IgE-mediated hypersensitivity with various cephalosporins. Avoidance of cephalosporins, when they are the drug of choice in a penicillin-allergic individual, results in significant morbidity that outweighs the low risk of anaphylaxis. We conclude that there is ample evidence to allow the safe use of cephalosporins in patients with isolated confirmed penicillin or amoxicillin allergy.
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Affiliation(s)
- Robert J Zagursky
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, Rochester, NY
| | - Michael E Pichichero
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, Rochester, NY.
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Fernandez TD, Mayorga C, Salas M, Barrionuevo E, Posadas T, Ariza A, Laguna JJ, Moreno E, Torres MJ, Doña I, Montañez MI. Evolution of diagnostic approaches in betalactam hypersensitivity. Expert Rev Clin Pharmacol 2017; 10:671-683. [PMID: 28375040 DOI: 10.1080/17512433.2017.1313110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Betalactams are the most widely used drugs against infections and the primary cause of antibiotic hypersensitivity reactions. Reaction patterns for different betalactams have been changing in accordance with consumption trends, and vary among countries. As a consequence, in vivo and in vitro tests have had to change with to keep up with new tendencies. Areas covered: This review is focused on advances in betalactam hypersensitivity diagnosis. Changes in in vivo methods have been limited to the inclusion of new haptens. In contrast, major progress has been achieved for in vitro tests since the 1960s, from the first description of immunoassays, the basophil activation test and the lymphocyte transformation test, to the more sophisticated assays developed in last years. Expert commentary: Issues with diagnosis are related to test sensitivity. In vivo tests show higher sensitivity, however they can be risky, especially in severe and life-threatening reactions. Therefore, we believe that in vitro tests should be the preferred method. Current efforts are under way to enhance their sensitivity. Only multidisciplinary approaches involving immunology, proteomics, nanotechnology and chemistry can help us to fully understand conjugate structures and mechanisms involved in hypersensitivity reactions to betalactams, and consequently lead to advances in in vitro methods.
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Affiliation(s)
- Tahia D Fernandez
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Cristobalina Mayorga
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Maria Salas
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Esther Barrionuevo
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Teresa Posadas
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Adriana Ariza
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Jose J Laguna
- c Allergy Unit , Hospital de la Cruz Roja , Madrid , Spain
| | - Esther Moreno
- d Allergy Service , University Hospital of Salamanca , Salamanca , Spain
| | - Maria J Torres
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain
| | - Inmaculada Doña
- b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain
| | - Maria I Montañez
- a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.,e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain
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Mesa-Antunez P, Collado D, Vida Y, Najera F, Fernandez T, Torres MJ, Perez-Inestrosa E. Fluorescent BAPAD Dendrimeric Antigens Are Efficiently Internalized by Human Dendritic Cells. Polymers (Basel) 2016; 8:E111. [PMID: 30979201 PMCID: PMC6432222 DOI: 10.3390/polym8040111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 12/29/2022] Open
Abstract
A new fluorescent dendrimeric antigen (DeAn) based on a dendron with amoxicilloyl terminal groups was synthesized. The synthesis was carried out using a novel class of all-aliphatic polyamide dendrimer (BisAminoalkylPolyAmide Dendrimers, or BAPAD) involving the direct condensation of 3,3'-diazidopivalic acid as a building block. Iterative azide reduction/amide formation increases the dendrimer generation. The BAPAD dendrimer was designed with a cystamine core. Reduction of the disulfide bond allows the incorporation of BAPAD dendrons into a 1,8-naphthalimide functionalized with a maleimide group. The fluorescence properties of DeAn were studied in PBS and compared with the properties of an equivalent dendron possessing amino-terminal groups. Both molecules shown high fluorescence quantum yields in PBS and could readily be visualized by fluorescence microscopy. DeAn was used as a synthetic antigen in a biomedical assay that tests their potential as an amoxicillin carrier in drug internalization by dendritic cells (DC) from tolerant and allergic patients. Cytometry data suggest that the dendrons are non-toxic and easily internalized by DCs, while confocal microscopy images indicate that the compounds are preferentially accumulated in the cytoplasm. These results indicate that BAPAD dendrons are good candidates for synthetic scaffolds for biomedical applications.
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Affiliation(s)
- Pablo Mesa-Antunez
- Department of Organic Chemistry, University of Malaga, IBIMA, 29071 Malaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology- BIONAND, Parque Tecnologico de Andalucia, 29590 Malaga, Spain.
| | - Daniel Collado
- Department of Organic Chemistry, University of Malaga, IBIMA, 29071 Malaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology- BIONAND, Parque Tecnologico de Andalucia, 29590 Malaga, Spain.
| | - Yolanda Vida
- Department of Organic Chemistry, University of Malaga, IBIMA, 29071 Malaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology- BIONAND, Parque Tecnologico de Andalucia, 29590 Malaga, Spain.
| | - Francisco Najera
- Department of Organic Chemistry, University of Malaga, IBIMA, 29071 Malaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology- BIONAND, Parque Tecnologico de Andalucia, 29590 Malaga, Spain.
| | - Tahia Fernandez
- Research Laboratory, Regional University Hospital of Malaga-IBIMA, 29010 Malaga, Spain.
| | - Maria Jose Torres
- Research Laboratory, Regional University Hospital of Malaga-IBIMA, 29010 Malaga, Spain.
- Allergy Service, Regional University Hospital of Malaga-IBIMA, 29010 Malaga, Spain.
| | - Ezequiel Perez-Inestrosa
- Department of Organic Chemistry, University of Malaga, IBIMA, 29071 Malaga, Spain.
- Andalusian Centre for Nanomedicine and Biotechnology- BIONAND, Parque Tecnologico de Andalucia, 29590 Malaga, Spain.
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Ariza A, Barrionuevo E, Mayorga C, Montañez M, Perez-Inestrosa E, Ruiz-Sánchez A, Rodríguez-Guéant R, Fernández T, Guéant J, Torres M, Blanca M. IgE to penicillins with different specificities can be identified by a multiepitope macromolecule. J Immunol Methods 2014; 406:43-50. [DOI: 10.1016/j.jim.2014.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/16/2014] [Accepted: 03/05/2014] [Indexed: 11/24/2022]
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IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities. Antibodies (Basel) 2014. [DOI: 10.3390/antib3010056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Torres MJ, Mayorga C, Blanca-López N, Blanca M. Hypersensitivity reactions to beta-lactams. EXPERIENTIA SUPPLEMENTUM (2012) 2014; 104:165-84. [PMID: 24214624 DOI: 10.1007/978-3-0348-0726-5_11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Beta-lactam antibiotics (BLs) are the most frequent cause of hypersensitivity reactions mediated by specific immunological mechanisms, with two main types, IgE reactions or T-cell-dependent responses. From a practical point of view, these reactions can be classified into immediate, for those appearing within 1 h after drug intake, and non-immediate, for those appearing at least 1 h after and usually within 24 h of BL administration. The clinical symptoms differ according to this classification. Urticaria and anaphylaxis are the most frequently recorded symptoms in immediate reactions and maculopapular exanthema and delayed urticaria in non-immediate reactions. Although the exact diagnostic approach differs depending on the underlying mechanism, it is based on the performance of skin testing, laboratory tests, and drug provocation tests.T cells are a key factor in all types of hypersensitivity reactions to BLs, regulating both IgE production or acting as effector cells, with a different profile of cytokine production. A Th1 pattern is observed in both CD4(+) and CD8(+) peripheral T cells in non-immediate reactions, whereas a Th2 pattern is expressed in CD4(+) T cells in immediate reactions.
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Affiliation(s)
- Maria J Torres
- Allergy Service, pabellón 6, primera planta, IBIMA, Carlos Haya Hospital (Pabellon C), Plaza del Hospital Civil, 29009, Malaga, Spain,
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Sharma AM, Uetrecht J. Bioactivation of drugs in the skin: relationship to cutaneous adverse drug reactions. Drug Metab Rev 2013; 46:1-18. [DOI: 10.3109/03602532.2013.848214] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yoon SY, Park SY, Kim S, Lee T, Lee YS, Kwon HS, Cho YS, Moon HB, Kim TB. Validation of the cephalosporin intradermal skin test for predicting immediate hypersensitivity: a prospective study with drug challenge. Allergy 2013; 68:938-44. [PMID: 23751142 DOI: 10.1111/all.12182] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cephalosporin is a major offending agent in terms of drug hypersensitivity along with penicillin. Cephalosporin intradermal skin tests (IDTs) have been widely used; however, their validity for predicting immediate hypersensitivity has not been studied. This study aimed to determine the predictive value of cephalosporin intradermal skin testing before administration of the drug. METHODS We prospectively conducted IDTs with four cephalosporins, one each of selected first-, second-, third-, or fourth-generation cephalosporins: ceftezol; cefotetan or cefamandole; ceftriaxone or cefotaxime; and flomoxef, respectively, as well as with penicillin G. After the skin test, whatever the result, one of the tested cephalosporins was administered intravenously and the patient was carefully observed. RESULTS We recruited 1421 patients who required preoperative cephalosporins. Seventy-four patients (74/1421, 5.2%) were positive to at least one cephalosporin. However, none of responders had immediate hypersensitivity reactions after a challenge dose of the same or different cephalosporin, which were positive in the skin test. Four patients who suffered generalized urticaria and itching after challenge gave negative skin tests for the corresponding drug. The IDT for cephalosporin had a sensitivity of 0%, a specificity of 97.5%, a negative predictive value of 99.7%, and a positive predictive value (PPV) of 0%, when challenged with the same drugs that were positive in the skin test. CONCLUSION Routine skin testing with a cephalosporin before its administration is not useful for predicting immediate hypersensitivity because of the extremely low sensitivity and PPV of the skin test (CRIS registration no. KCT0000455).
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Affiliation(s)
- S.-Y. Yoon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - S. Y. Park
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - S. Kim
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - T. Lee
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - Y. S. Lee
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - H.-S. Kwon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - Y. S. Cho
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - H.-B. Moon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
| | - T.-B. Kim
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul; Korea
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Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins. Clin Rev Allergy Immunol 2013; 45:131-42. [DOI: 10.1007/s12016-013-8367-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gómez E, Torres MJ, Mayorga C, Blanca M. Immunologic evaluation of drug allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:251-63. [PMID: 22950030 PMCID: PMC3423598 DOI: 10.4168/aair.2012.4.5.251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/01/2012] [Indexed: 12/21/2022]
Abstract
Hypersensitivity drug reactions (HDR) consist of an individual abnormal response with the involvement of the immunological system. In addition to specific immunological mechanisms where specific antibodies or sensitised T cells participate, release of inflammatory mediators by non-specific immunological recognition may also occur. Within this category are one of the most common groups of drugs, the non-steroidal anti-inflammatory drugs. In addition to chemical drugs new emerging ones with an increasing protagonism are biological agents like humanised antibodies and others. For IgE dependent reactions both in vivo and in vitro tests can be used for the immunological evaluation. Sensitivity of these is not optimal and very often a drug provocation test must be considered for knowing the mechanism involved and/or establishing the diagnosis. For non-immediate reactions also both in vivo and in vitro tests can be used. Sensitivity for in vivo tests is generally low and in vitro tests may be needed for the immunological evaluation. Immunohistochemical studies of the affected tissue enable a more precise classification of non-immediate reactions. The monitorization of the acute response of the reactions has given clues for understanding these reactions and has promising results for the future of the immunological evaluation of HDR.
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Affiliation(s)
- Enrique Gómez
- Research Laboratory, Carlos Haya Hospital, Málaga, Spain
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