Cross-reactivity in beta-lactams after a non-immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions. Lunes 21 de septiembre

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 Cross-reactivity in beta-lactams after a non-immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions

Authors: V. Berot,1 G. Gener,1,2,† S. Ingen-Housz-Oro,1,2,3,† O. Gaudin,1,2 M. Paul,3,4 O. Chosidow,1,2,5 P. Wolkenstein,1,2,5, H. Assier1,2,*

Abstract

Background Cross-reactivity among beta-lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross-reactivity beyond BLs in patients with non-immediate cutaneous adverse drug reaction (non-immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single-centre study in consecutive patients consulting between 2010 and 2018 with an active BL-suspected non-immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P-IDR)] for at least three penicillin’s subclasses and amino- and non-amino-cephalos- porins (at least one aminocephalosporin). Cross-reactivity among subclasses was investigated for patients with positive tests.

Results We included 56 patients, among whom 46 amoxicillin-suspected were and seven cephalosporin-suspected. Twenty-nine had severe CADR, and 27 had non-immediate maculopapular exanthema (MPE). Twenty-two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin-suspected, 10 (55.6%) showed cross-reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non-aminocephalosporin. No amoxicillin- or cephalosporin-suspected patient showed cross-reactivity with aztreonam or carbapenems. P-IDR showed cross-reac- tivity only once.

Conclusion After a suspected BL-induced non-immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross-reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross-reactivity was frequent and PT was sufficient to this purpose. The frequent cross-reactivity among peni- cillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross- allergies are rarer.

DOI 10.1111/jdv.15986

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