Skip to main content

Advertisement

SpringerLink
Log in

How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects

  • Drug Allergy (MJ Torres Jaén, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of study

Cystic fibrosis (CF) is a complex genetic disease with high mortality, of which 85% is a result of lung disease characterized by serious endobronchial infections.

Recent findings

Antibiotic therapy is one of the main treatments of CF, both during acute exacerbations and as chronic maintenance medications, contributing to a prolonged survival. Since neonatal CF screening programs have been implemented universally and the longevity of patients with CF steadily increases, antibiotic hypersensitivity reactions (HSRs) are becoming more important. HSR to antibiotics in CF has been reported since the 1980s and was estimated to occur up to three times more frequently in these patients, probably owing to high rates of antibiotic exposure and boosting stimuli such as infections and inflammation. However, recent studies including large groups of CF patients with a suspicion of antibiotic allergy have used diagnostic algorithms including skin tests and drug provocation tests and showed that true incidence was much lower. The mechanism of the reactions and the clinical presentations are not different in CF than in the general population. Both the immediate and nonimmediate type HSRs are seen, and among the latter, drug fever and drug-induced hemolytic anemia are distinctive presentations. Beta-lactam (BL) agents are the most common cause, with higher rates for ureidopenicillins (piperacillin, mezlocillin, and piperacillin/tazobactam) and cephalosporins (especially ceftazidime), intermediate rates for carbapenems, and lowest rates for aztreonam, and also HSRs to aminoglycosides, macrolides, and quinolones are encountered. Since the available choices for antibiotic therapy are limited due to relevant organisms, management becomes a challenge. It is essential to evaluate the patients according to the mechanism of the HSR and determine the risk of repeat administration of the culprit drug and also safety of alternative drugs with prior skin and provocation tests. The chemical structure and side chains must be taken into account when selecting a safe alternative drug.

Summary

Contrary to what was previously thought, recent data on cross-reactions between BL antibiotics showed that some BLs can be an option of treatment for patients allergic to other BLs. Desensitization is a useful procedure in immediate and some delayed reactions, if a suitable alternative antibiotic is not available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. O’Sullivan BP, Freedman SD. Cystic fibrosis. Lancet. 2009;373(9678):1891–904.

    Article  PubMed  Google Scholar 

  2. Griesenbach U, Geddes D, Alton E. The pathogenic consequences of a single mutated CFTR gene. Thorax. 1999;54:S19–23.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Farrell PM, Rosenstein BJ, White TB, et al. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: cystic fibrosis foundation consensus report. J Pediatr. 2008;153(2):S4–14.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Grosse SD, Boyle CA, Botkin JR, et al. Newborn screening for cystic fibrosis: evaluation of benefits and risks and recommendations for state newborn screening programs. MMWR Recomm Rep. 2004;53(RR–13):1–36.

    Google Scholar 

  5. Cystic Fibrosis Foundation Patient Registry. annual data report. Bethesda (MD): Cystic Fibrosis Foundation; 2014. p. 2015.

    Google Scholar 

  6. Salsgiver EL, Fink AK, Knapp EA, et al. Changing epidemiology of the respiratory bacteriology of patients with cystic fibrosis. Chest. 2015;149(2):390–400.

    Article  Google Scholar 

  7. Parkins MD, Floto RA. Emerging bacterial pathogens and changing concepts of bacterial pathogenesis in cystic fibrosis. J Cyst Fibros. 2015;14:293–304.

    Article  CAS  PubMed  Google Scholar 

  8. Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med. 2003;168:918–51.

    Article  PubMed  Google Scholar 

  9. Campbell CT, McCaleb R, Manasco KB. New inhaled antimicrobial formulations for use in the cystic fibrosis patient population. Ann Pharmacother. 2016;50(2):133–40. https://doi.org/10.1177/1060028015621916.

    Article  CAS  PubMed  Google Scholar 

  10. Ferkol T, Rosenfeld M, Milla CE. Cystic fibrosis pulmonary exacerbations. J Pediatr. 2006;148:259–64.

    Article  PubMed  Google Scholar 

  11. •• Flume PA, Mogayzel PJ, Robinson KA, and the Clinical Practice Guidelines for Pulmonary Therapies Committee, et al. Cystic fibrosis pulmonary guidelines treatment of pulmonary exacerbations. Am J Respir Crit Care Med. 2009;180:802–8. Clinical practice guideline for CF treatment

    Article  PubMed  Google Scholar 

  12. •• Flume PA, O’Sullivan BP. Robinson KA, et al. Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. Am J Respir Crit Care Med. 2007;176:957–69. Clinical practice guideline for CF treatment

    Article  CAS  PubMed  Google Scholar 

  13. Cystic Fibrosis Foundation. Patient registry 1975 annual report. Atlanta (GA): Cystic Fibrosis Foundation; 1975.

    Google Scholar 

  14. Mac Kenzie T, Gifford AH, Sabadosa KA, et al. Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the Cystic Fibrosis Foundation patient registry. Ann Intern Med. 2014;161(4):233–41. https://doi.org/10.7326/M13-0636.

    Article  Google Scholar 

  15. Parmar JS, Nasser S. Antibiotic allergy in cystic fibrosis. Thorax. 2005;60(6):517–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. • Rubio M, Bousquet PJ, Gomes E, Romano A, Demoly P. Results of drug hypersensitivity evaluations in a large group of children and adults. Clin Exp Allergy. 2012;42(1):123–30. One of the unique drug hypersensitivity studies that include evaluation of both adults and children.

    Article  CAS  PubMed  Google Scholar 

  17. Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005;5(4):309–16.

    Article  PubMed  Google Scholar 

  18. Bouvy JC, De Bruin ML, Koopmanschap MA. Epidemiology of adverse drug reactions in Europe: a review of recent observational studies. Drug Saf. 2015;38(5):437–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bourgeois FT, Shannon MW, Valim C, et al. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010;19:901–10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. • Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the nomenclature review committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113:832–6. Last updated global allergy nomenclature is reported.

    Article  CAS  PubMed  Google Scholar 

  21. Park CS, Kim TB, Kim SL, Kim JY, Yang KA, Bae YJ, et al. The use of an electronic medical record system for mandatory reporting of drug hypersensitivity reactions has been shown to improve the management of patients in the university hospital in Korea. Pharmacoepidemiol Drug Saf. 2008;17:919–25.

    Article  PubMed  Google Scholar 

  22. Thong BY, Leong KP, Tang CY, Chng HH. Drug allergy in a general hospital: results of a novel prospective inpatient reporting system. Ann Allergy Asthma Immunol. 2003;90:342–7.

    Article  PubMed  Google Scholar 

  23. •• The Joint Task Force on Practice Parameters. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105:259–73.e78. Practice parameter of American Academy of Allergy, asthma immunology on drug allergy.

    Article  Google Scholar 

  24. Bigby M, Jick S, Jick H, Arndt K. Drug induced cutaneous reactions: a report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA. 1986;256:3358–63.

    Article  CAS  PubMed  Google Scholar 

  25. Kidon MI, See Y. Adverse drug reactions in Singaporean children. Singapore Med J. 2004;45:574–7.

    CAS  PubMed  Google Scholar 

  26. Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruption among children and adolescents in North India. Pediatr Dermatol. 1995;12:178–83.

    Article  CAS  PubMed  Google Scholar 

  27. Macy E, Poon KWT. Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med. 2009;122. 778:e1–778.e7.

    Google Scholar 

  28. Orhan F, Karakas T, Cakir M, Akkol N, Bahat E, Sonmez FM, et al. Parental-reported drug allergy in 6- to 9-yr-old urban schoolchildren. Pediatr Allergy Immunol. 2008;19:82–5.

    PubMed  Google Scholar 

  29. Rebelo GE, Fonseca J, Araujo L, et al. Drug allergy claims in children: from self-reporting to confirmed diagnosis. Clin Exp Allergy. 2008;38:191–8.

    Google Scholar 

  30. Erkoçoğlu M, Kaya A, Civelek E, Ozcan C, Cakır B, Akan A, et al. Prevalence of confirmed immediate type drug hypersensitivity reactions among school children. Pediatr Allergy Immunol. 2013;24(2):160–7. https://doi.org/10.1111/pai.12047.

    Article  PubMed  Google Scholar 

  31. Lammintausta K, Kortekangas-Savolainen O. Oral challenge in patients with suspected cutaneous adverse drug reactions: findings in 784 patients during a 25-year-period. Acta Derm Venereol. 2005;85:491–6.

    PubMed  Google Scholar 

  32. García Núñez I, Barasona Villarejo MJ, Algaba Mármol MA, Moreno Aguilar C, Guerra Pasadas F. Diagnosis of patients with immediate hypersensitivity to beta-lactams using retest. J Investig Allergol Clin Immunol. 2012;22:41–7.

    PubMed  Google Scholar 

  33. •• Ponvert C, Perrin Y, Bados-Albiero A, Le Bourgeois M, Karila C, Delacourt C, et al. Allergy to BL antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol. 2011;22:411–8. This study included the evaluation of the largest series of beta-lactam hypersensitivity reactions in children.

    Article  CAS  PubMed  Google Scholar 

  34. •• Harandian F, Pham D, Ben-Shoshan M. Positive penicillin allergy testing results: a systematic review and meta-analysis of papers published from 2010 through 2015. Postgrad Med. 2016;128(6):557–62. https://doi.org/10.1080/00325481.2016.1191319. First meta-analysis on the prevalence of real BL allergy.

    Article  PubMed  Google Scholar 

  35. Zopf Y, Rabe C, Neubert A, Hahn EG, Dormann H. Risk factors associated with adverse drug reactions following hospital admission: a prospective analysis of 907 patients in two German university hospitals. Drug Saf. 2008;31:789–98.

    Article  PubMed  Google Scholar 

  36. •• Rashed AN, Wong IC, Cranswick N, Tomlin S, Rascher W, Neubert A. Risk factors associated with adverse drug reactions in hospitalised children: international multicentre study. Eur J Clin Pharmacol. 2012;68:801–10. A first prospective observational international cohort study on the risk factors of ADRs conducted in five European and non-European countries including 1340 child admissions.

    Article  CAS  PubMed  Google Scholar 

  37. Mirakian R, Ewan PW, Durham SR, et al. BSACI guidelines for the management of drug allergy. Clin Exp Allergy. 2008;39:43–61.

    Article  CAS  Google Scholar 

  38. • Pirmohamed M, Naisbitt DJ, Gordon F, Park BK. The danger hypothesis—potential role in idiosyncratic drug reactions. Toxicology. 2002;181–182:55–63. A breakthrough paper about the introduction of danger hypothesis into drug allergy

    Article  PubMed  Google Scholar 

  39. Matzinger P. The danger model: a renewed sense of self. Science. 2002;296:301–5.

    Article  CAS  PubMed  Google Scholar 

  40. McDonnell TJ, FitzGerald MX. Cystic fibrosis and penicillin hypersensitivity. Lancet. 1984;1(8389):1301–2.

    Article  CAS  PubMed  Google Scholar 

  41. Brock PG, Roach M. Adverse reactions to piperacillin in cystic fibrosis. Lancet. 1984;1(8385):1070–1.

    Article  CAS  PubMed  Google Scholar 

  42. Burrows JA, Nissen LM, Kirkpatrick CM, Bell SC. Beta-lactam allergy in adults with cystic fibrosis. J Cyst Fibros. 2007;6(4):297–303.

    Article  CAS  PubMed  Google Scholar 

  43. Koch C, Hjelt K, Pedersen SS, Jensen ET, Jensen T, Lanng S, et al. Retrospective clinical study of hypersensitivity reactions to aztreonam and six other beta-lactam antibiotics in cystic fibrosis patients receiving multiple treatment courses. Rev. Infect Dis. 1991;13(Suppl 7):S608–11.

    Article  Google Scholar 

  44. Roehmel JF, Schwarz C, Mehl A, Stock P, Staab D. Hypersensitivity to antibiotics in patients with cystic fibrosis. J Cyst Fibros. 2014;13:205–21.

    Article  CAS  PubMed  Google Scholar 

  45. Reid A, Jenkins L, Devlin L, Shendi H, Ansotegui I, Fair R, et al. Adverse reactions to parenteral antibiotics in a pediatric CF population over a 5-year period. Pediatr Pulmonol. 2008;43(S31):329.

    Google Scholar 

  46. Wills R, Henry RL, Francis JL. Antibiotic hypersensitivity reactions in cystic fibrosis. J Paediatr Child Health. 1998;34(4):325–9.

    Article  CAS  PubMed  Google Scholar 

  47. Nikolaizik WH, Trociewicz K, Ratjen F. Bronchial reactions to the inhalation of high-dose tobramycin in cystic fibrosis. Eur Respir J. 2002;20(1):122–6.

    Article  CAS  PubMed  Google Scholar 

  48. Spigarelli M, Nasr S. Hypersensitivity to inhaled TOBI following reaction to gentamycin. Pediatr Pulmonol. 2002;33:311–4.

    Article  PubMed  Google Scholar 

  49. Møller NE, Ahlstedt S, Skov PS, Norn S. Allergological examination of cystic fibrosis patients with skin reactions during carbenicillin treatment. Allergy. 1980;35(2):135–8.

    Article  PubMed  Google Scholar 

  50. Moss RB, Babin S, Hsu YP, Blessing-Moore J, Lewiston NJ. Allergy to semisynthetic penicillins in cystic fibrosis. J Pediatr. 1984;104(3):460–6.

    Article  CAS  PubMed  Google Scholar 

  51. • Caimmi S, Sanfiorenzo C, Caimni D, Bousquet PJ, Chiron R, Demoly P. Comprehensive allergy work-up is mandatory in cystic fibrosis patients who report a history suggestive of drug allergy to BL antibiotics. Clin Transl Allergy. 2012;2:10. A comprehensive study that evaluated suspicion of drug reactions with diagnostic tests in a substantial number of cystic fibrosis patients

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. • Matar R, Le Bourgeois M, Scheinmann P, de Blic J, Ponvert C. Beta-lactam hypersensitivity in children with cystic fibrosis: a study in a specialized pediatric center for cystic fibrosis and drug allergy. Pediatr Allergy Immunol. 2014;25(1):88–93. One of the few studies that evaluated suspicion of drug reactions with tests in children with cystic fibrosis

    Article  PubMed  Google Scholar 

  53. Petroni DH, Aitken ML, Ham E, Chung S, Menalia L, Altman MC, et al. Approach to the evaluation of adverse antibiotic reactions in patients with cystic fibrosis. Ann Allergy Asthma Immunol. 2016;117(4):378–81. https://doi.org/10.1016/j.anai.2016.07.039.

    Article  CAS  PubMed  Google Scholar 

  54. Husby S. Sensitization and tolerance. Curr Opin Allergy Clin Immunol. 2001;1:237–41.

    Article  CAS  PubMed  Google Scholar 

  55. Matar R, Le Bourgeois L, Scheinmann P, de Blic J, Ponvert C. Regarding the article entitled “Hypersensitivity to antibiotics in patients with cystic fibrosis”. J Cystic Fibrosis. 2014;13(2):238–9.

  56. Shiohara T, Kano Y. A complex interaction between drug allergy and viral infection. Clin Rev. Allergy Immunol. 2007;33:124–33.

    Article  CAS  PubMed  Google Scholar 

  57. Adam J, Pichler WJ, Yerly D. Delayed drug hypersensitivity: models of T-cell stimulation. Br J Clin Pharmacol. 2011;71:701–7. A comprehensive and innovative review of immunopathomechanism of delayed type drug hypersensitivity.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Blanca M, Torres MJ, Garcia JJ, Romano A, Mayorga C, de Ramaon E, et al. Natural evolution of skin test sensitivity in patients allergic to BL antibiotics. J Allergy Clin Immunol. 1999;103:918–24.

    Article  CAS  PubMed  Google Scholar 

  59. Fernández TD, Torres MJ, Blanca-López N, Rodríguez-Bada JL, Gomez E, Canto G, et al. Negativization rates of IgE radioimmunoassay and basophil activation test in IRs to penicillins. Allergy. 2009;64:242–8.

    Article  PubMed  CAS  Google Scholar 

  60. Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med. 2003;139:683–93.

    Article  CAS  PubMed  Google Scholar 

  61. •• Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, et al. International consensus on drug allergy. Allergy. 2014;69:420–37. WAO-EAACI consensus paper on drug allergy

    Article  CAS  PubMed  Google Scholar 

  62. Bircher AJ, Scherer Hofmeier K. Drug hypersensitivity reactions: inconsistency in the use of the classification of immediate and NIRs. J Allergy Clin Immunol. 2012;129:263–4.

    Article  PubMed  Google Scholar 

  63. Romano A, Torres MJ, Castells M, Sanz ML, Blanca M. Diagnosis and management of drug hypersensitivity reactions. J Allergy Clin Immunol. 2011;127:S67–73.

    Article  CAS  PubMed  Google Scholar 

  64. García Rodríguez R, Galindo Bonilla PA, Feo Brito FJ, Gómez Torrijos E, de Borja Sega J, de la Lara Rosa P, et al. Chronic desensitization to quinolones in fixed drug eruption. J Investig Allergol Clin Immunol. 2011;21(1):76–7.

    PubMed  Google Scholar 

  65. Ben Mansour A, Bellon N, Frassati-Biaggi A, Sermet-Gaudelus I, Ponvert C, de Blic J, Lezmi G. Multifocal fixed drug eruption to ceftazidime in a child with cystic fibrosis. Pediatr Allergy Immunol 2017. doi: https://doi.org/10.1111/pai.12829.

  66. Gohy S, Froidure A, Lebecque P. DRESS syndrome in a patient with cystic fibrosis: a case report. Pediatr Pulmonol. 2017;52(4):E18–21. https://doi.org/10.1002/ppul.23567.

    Article  PubMed  Google Scholar 

  67. Tremblay F, Chapdelaine H, Lavoie A, Berthiaume Y, Sabbah L, Bernstein SC, et al. Toxic epidermal necrolysis in a patient with cystic fibrosis. J Allergy Clin Immunol Pract. 2016;4(3):526–8. https://doi.org/10.1016/j.jaip.2015.11.021.

    Article  PubMed  Google Scholar 

  68. •• Levi N, Bastuji-Garin S, Mockenhaupt M, Ark VE. Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis. Pediatrics. 2009;123(2):e297–304. A first prospective multinational study of SJS/TEN among children

    Article  PubMed  Google Scholar 

  69. •• Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, Creamer D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071–80. A prospective multinational study of severe drug reactions involving and evaluating a huge number of well-defined DRESS cases from different populations.

    Article  CAS  PubMed  Google Scholar 

  70. Stead RJ, Kennedy HG, Hodson ME, Batten JC. Adverse reactions to piperacillin in adults with cystic fibrosis. Thorax. 1985;40(3):184–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Pleasants R, Walker T, Samuelson W. Allergic reactions to parenteral BL antibiotics in patients with cystic fibrosis. Chest. 1994;106:1124–8.

    Article  CAS  PubMed  Google Scholar 

  72. Mackowiak PA. Drug fever: mechanisms, maxims and misconceptions. Am J Med Sci. 1987;294(4):275.

    Article  CAS  PubMed  Google Scholar 

  73. Patel RA, Gallagher JC. Drug fever. Pharmacotherapy. 2010 Jan;30(1):57–69. https://doi.org/10.1592/phco.30.1.57.

  74. Chavez A, Mian A, Scurlock AM, et al. Antibiotic hypersensitivity in CF: drug-induced life-threatening hemolytic anemia in a pediatric patient. J Cystic Fib. 2010;9:433–8.

    Article  CAS  Google Scholar 

  75. Mayer B, Yurek S, Salama A. Piperacillin-induced immune hemolysis: new cases and a concise review of the literature. Transfusion. 2010;50:1135–8.

    Article  PubMed  Google Scholar 

  76. Reichardt P, Handrick W, Linke A, Schille R, Kiess W. Leukocytopenia, thrombocytopenia and fever related to piperacillin/tazobactam treatment—a retrospective analysis in 38 children with cystic fibrosis. Infection. 1999;27(6):355–6.

    Article  CAS  PubMed  Google Scholar 

  77. Bandara M, Seder DB, Garratty G, Leger RM, Zuckerman JB. Piperacillin induced immune hemolytic anemia in an adult with cystic fibrosis. Case Report Med. 2010;2010:161,454.

    Article  Google Scholar 

  78. Maiz L, Giron RM, Olveira C, et al. Inhaled antibiotics for the treatment of chronic bronchopulmonary pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials. Expert Opin Pharmacother. 2013;14(9):1135–49.

    Article  CAS  PubMed  Google Scholar 

  79. Oermann CM, Retsch Bogard GZ, Quittner AL, Gibson RL, McCoy KS, Montgomery AB, et al. An 18-month study of the safety and efficacy of repeated courses of inhaled aztreonam lysine in cystic fibrosis. Pediatr. Pulmonol. 2010;45:1121–34.

    Article  PubMed  Google Scholar 

  80. •• Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014;133(3):790–6. A landmark-matched cohort study on over 100,000 patients about the relation between penicillin allergy label and antibiotic resistance.

    Article  PubMed  Google Scholar 

  81. Fishman N, Patterson J, Saiman L, et al. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33:322–7.

    Article  Google Scholar 

  82. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Fishman NO, et al. Implementing an Antibiotic Stewardship Program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51–77.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Schnyder B. Approach to the patient with drug allergy. Med Clin North Am. 2010;94(4):665–79, xv. https://doi.org/10.1016/j.mcna.2010.03.006.

    Article  PubMed  Google Scholar 

  84. •• Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions. Allergo J Int. 2015;24:94–105. https://doi.org/10.1007/s40629-015-0052. Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group, the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM) about drug hyperesnsitivity.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy. 1999;54(9):999–1003.

    Article  CAS  PubMed  Google Scholar 

  86. Scherer K, Bircher AJ. Danger signs in drug hypersensitivity. Med Clin N Am. 2010;94:681–9.

    Article  PubMed  Google Scholar 

  87. Brockow K, Romano A. Skin tests in the diagnosis of drug hypersensitivity reactions. Curr Pharm Des. 2008;14:2778–91.

    Article  CAS  PubMed  Google Scholar 

  88. Mayorga C, Celik G, Rouzaire P, Whitaker P, Bonadonna P, Cernadas JR, et al. In vitro tests for drug hypersensitivity reactions: an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2016;71:1103–34.

    Article  CAS  PubMed  Google Scholar 

  89. Torres MJ, Romano A, Celik G, Demoly P, Khan D, Macy E, et al. Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America. Clin Transl Allergy. 2017;7:7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Kano Y, Hirahara K, Mitsuyama Y, et al. Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Allergy. 2007;62:1439–44.

    Article  CAS  PubMed  Google Scholar 

  91. Barbaud A. Skin testing in delayed reactions to drugs. Immunol Allergy Clin N Am. 2009;29:517–35.

    Article  Google Scholar 

  92. •• Blanca M, Romano A, Torres MJ, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy. 2009;64:183–93. Position paper of EAACI/ENDA on betalactam allergies.

    Article  CAS  PubMed  Google Scholar 

  93. Romano A, Valluzzi RL, Caruso C, et al. Non-immediate cutaneous reactions to beta-lactams: approach to diagnosis. Curr Allergy Asthma Rep. 2017;17(4):23. https://doi.org/10.1007/s11882-017-0691-4.

    Article  PubMed  CAS  Google Scholar 

  94. •• Torres MJ, Blanca M, European Network for Drug Allergy [ENDA]; EAACI Interest Group on Drug Hypersensitivity. Importance of skin testing with major and minor determinants of benzylpenicillin in the diagnosis of allergy to BLs. Statement from the European Network for Drug Allergy concerning AllergoPen withdrawal. Allergy. 2006;61:910–1. Statement of EAACI/ENDA on skin tests in betalactam allergies

    Article  CAS  PubMed  Google Scholar 

  95. Torres MJ, Ariza A, Mayorga C, Dona I, Blanca-Lopez N, Rondon C, et al. Clavulanic acid can be the component in amoxicillin-clavulanic acid responsible for immediate hypersensitivity reactions. J Allergy Clin Immunol. 2010;125(2):502–5. e502

  96. Kuyucu S, Mori F, Atanaskovic-Markovic M, Caubet JC, Terreehorst I, Gomes E, et al. Hypersensitivity reactions to non-betalactam antibiotics in children: an extensive review. Pediatr Allergy Immunol. 2014;25(6):534–43. https://doi.org/10.1111/pai.12273.

    PubMed  Google Scholar 

  97. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol. 2003;112:629–30.

    Article  CAS  PubMed  Google Scholar 

  98. Brož P, Harr T, Hecking C, Grize L, Scherer K, Jaeger KA, et al. Nonirritant intradermal skin test concentrations of ciprofloxacin, clarithromycin, and rifampicin. Allergy. 2012;67(5):647–52. https://doi.org/10.1111/j.1398-9995.2012.02807.

    Article  PubMed  CAS  Google Scholar 

  99. •• Brockow K, Garvey LH, Aberer W, ENDA/EAACI Drug Allergy Interest Group, et al. Skin test concentrations for systemically administered drugs—an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702–12. ENDA/EAACI position paper on skin test concentrations of systemic drugs in the diagnosis of drug allergy

    Article  CAS  PubMed  Google Scholar 

  100. Cavkaytar O, Karaatmaca B, Yilmaz EA, Sekerel BE, Soyer O. Testing for clarithromycin hypersensitivity: a diagnostic challenge in childhood. J Allergy Clin Immunol Pract. 2016;4(2):330–2.e1. https://doi.org/10.1016/j.jaip.2015.09.015.

    Article  PubMed  Google Scholar 

  101. •• Barbaud A, Collet E, Milpied B, Assier H, on behalf of the Toxidermies group of the French Society of Dermatology, et al. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol. 2013;168(3):555–62. A primer and unique multicenter study on the use of patch tests in severe reactions

    Article  CAS  PubMed  Google Scholar 

  102. Barbaud A. Drug patch testing in systemic cutaneous drug allergy. Toxicology. 2005;209:209–16.

    Article  CAS  PubMed  Google Scholar 

  103. Cham P, Warshaw EM. Patch testing for evaluating dug reactions due to systemic antibiotics. Dermatitis. 2007;18(2):63–77.

    Article  CAS  PubMed  Google Scholar 

  104. Romano A, Viola M, Gaeta F, Rumi G, Maggioletti M. Patch testing in non-immediate drug eruptions. Allergy Asthma Clin Immunol. 2008;4(2):66–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. • Pinho A, Coutinho I, Gameiro A, Gouveia M, Gonçalo M. Patch testing—a valuable tool for investigating non-immediate cutaneous adverse drug reactions to antibiotics. J Eur Acad Dermatol Venereol. 2017;31:280–7. This large study emphasizes the diagnostic value of patch tests in evaluating non-immediate reactions to antibiotics, including beta-lactams.

    Article  CAS  PubMed  Google Scholar 

  106. Chiriac AM, Demoly P. Drug provocation tests: up-date and novel approaches. Allergy Asthma Clin Immunol. 2013;9(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  107. •• Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003;58:854–63. Position paper of ENDA/EAACI on drug provocation tests.

    Article  CAS  PubMed  Google Scholar 

  108. Bousquet PJ, Gaeta F, Bousquet-Rouanet L, Lefrant JY, Demoly P, Romano A. Provocation tests in diagnosing drug hypersensitivity. Curr Pharm Des. 2008;14(27):2792–802.

    Article  CAS  PubMed  Google Scholar 

  109. Ratzon R, Reshef A, Efrati O, Deutch M, Forschmidt R, Cukierman-Yaffe T, et al. Impact of an extended challenge on the effectiveness of β-lactam hypersensitivity investigation. Ann Allergy Asthma Immunol. 2016;116(4):329–33. https://doi.org/10.1016/j.anai.2016.01.018.

    Article  CAS  PubMed  Google Scholar 

  110. Hjortlund J, Mortz CG, Skov PS, et al. One-week oral challenge with penicillin in diagnosis of penicillin allergy. Acta Derm Venereol. 2012;92:307–12.

    Article  CAS  PubMed  Google Scholar 

  111. •• Gomes ER, Brockow K, Kuyucu S, Saretta F, Mori F, Blanca-Lopez N, et al. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy. 2016;71(2):149–61. https://doi.org/10.1111/all.12774. First report on the management of drug hypersensitivity in children by Pediatric Task Force of EAACI drug allergy group.

    Article  CAS  PubMed  Google Scholar 

  112. Caubet JC, Frossard C, Fellay B, Eigenmann PA. Skin tests and in vitro allergy tests have a poor diagnostic value for benign skin rashes due to β-lactams in children. Pediatr Allergy Immunol. 2015;26:80–2.

    Article  PubMed  Google Scholar 

  113. Marrs T, Fox AT, Lack G, du Toit G. The diagnosis and management of antibiotic allergy in children: systematic review to inform a contemporary approach. Arch Dis Child. 2015;100:583–8.

    Article  PubMed  Google Scholar 

  114. Paulmann M, Mockenhaupt M. Severe drug hypersensitivity reactions: clinical pattern, diagnosis, etiology and therapeutic options. Curr Pharm Des. 2016;22(45):6852–61. https://doi.org/10.2174/1381612822666160928125152.

    Article  CAS  PubMed  Google Scholar 

  115. Limsuwan T, Demoly P. Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock). Med Clin North Am. 2010;94:691–710.

    Article  PubMed  Google Scholar 

  116. Gruchalla RS, Pirmohamed M. Clinical practice. Antibiotic allergy. N Engl J Med. 2006 Feb 9;354(6):601–9.

  117. Torres MJ, Blanca M. The complex clinical picture of beta-lactam hypersensitivity: penicillins, cephalosporins, monobactams, carbapenems, and clavams. Med Clin North Am. 2010;94:805–20.

    Article  CAS  PubMed  Google Scholar 

  118. Pichichero ME, Zagursky R. Penicillin and cephalosporin allergy. Ann Allergy Asthma Immunol. 2014;112:404–12.

    Article  PubMed  Google Scholar 

  119. Solensky R. Hypersensitivity reactions to beta-lactam antibiotics. Clin Rev Allergy Immunol. 2003;24:201–20.

    Article  CAS  PubMed  Google Scholar 

  120. Montanez MI, Ariza A, Mayorga C, Fernandez TD, Torres MJ. Cross-reactivity in betalactam allergy: alternative treatments. Curr Treat Options Allergy. 2015;2:141–54.

    Article  Google Scholar 

  121. Romano A, Gaeta F, Arribas Poves MF, Valluzzi RL. Cross-reactivity among beta-lactams. Curr Allergy Asthma Rep. 2016;16(3):24. https://doi.org/10.1007/s11882-016-0594-9.

    Article  PubMed  CAS  Google Scholar 

  122. Cabanas R, Munoz L, Lopez-Serrano C, et al. Hypersensitivity to piperacillin. Allergy. 1998;53:819–20.

    Article  CAS  PubMed  Google Scholar 

  123. Romano A, Di Fonso M, Viola M, et al. Selective hypersensitivity to piperacillin. Allergy. 2000;55:787.

    Article  CAS  PubMed  Google Scholar 

  124. Lee QU. Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited. Hong Kong Med J. 2014;20:428–36.

    Article  CAS  PubMed  Google Scholar 

  125. Blumenthal KG, Shenoy ES, Varughese CA, Hurwitz S, Hooper DC, Banerji A. Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy. Ann Allergy Asthma Immunol. 2015;115:294–300.

    Article  PubMed  PubMed Central  Google Scholar 

  126. •• Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136:340–7. A metaanalysis of penicillin-cephalosporin cross reactions.

    Article  PubMed  Google Scholar 

  127. Romano A, Guéant-Rodriguez RM, Viola M, Pettinato R, Guéant JL. Cross-reactivity and tolerability of cephalosporins in patients with immediate hypersensitivity to penicillins. Ann Intern Med. 2004;141(1):16–22.

    Article  CAS  PubMed  Google Scholar 

  128. • Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Caruso C, Quaratino D. Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2016;138:179–86. A study demonstrating a rate of cross-reactivity between aminopenicillins and aminocephalosporins of around 20%, as well as the tolerability of aztreonam, cefuroxime, and ceftriaxone in more than 200 subjects with a T cell-mediated hypersensitivity to penicillins.

    Article  CAS  PubMed  Google Scholar 

  129. Romano A, Gaeta F, Valluzzi RL, Maggioletti M, Zaffiro A, Caruso C, et al. IgE-mediated hypersensitivity to cephalosporins: cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol. 2015;136(3):685–691.e3. https://doi.org/10.1016/j.jaci.2015.03.012.

    Article  CAS  PubMed  Google Scholar 

  130. Zagursky RJ, Pichichero ME. Cross-reactivity in β-lactam allergy. J Allergy Clin Immunol Pract. 2018;6(1):72–81.e1. https://doi.org/10.1016/j.jaip.2017.08.027.

  131. Lagacé-Wiens P, Rubinstein E. Adverse reactions to β-lactam antimicrobials. Expert Opin Drug Saf. 2012;11(3):381–99. https://doi.org/10.1517/14740338.2012.643866.

    Article  PubMed  CAS  Google Scholar 

  132. • Antunez C, Blanca-Lopez N, Torres MJ, Mayorga C, Perez-Inestrosa E, Montañez MI, et al. Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins. J Allergy Clin Immunol. 2006;117(2):404–10. A large scale study on the betalactam cross reactions

    Article  CAS  PubMed  Google Scholar 

  133. Cunha BA. Antibiotic selection in the penicillin-allergic patient. Med Clin North Am. 2006;90(6):1257–64.

    Article  CAS  PubMed  Google Scholar 

  134. Atanaskovic-Markovic M, Gaeta F, Medjo B, Viola M, Nestorovic B, Romano A. Tolerability of meropenem in children with IgE-mediated hypersensitivity to penicillins. Allergy. 2008;63:237–40.

    Article  CAS  PubMed  Google Scholar 

  135. Gaeta F, Valluzzi RL, Alonzi C, Maggioletti M, Caruso C, Romano A. Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol. 2015;135(4):972–6. https://doi.org/10.1016/j.jaci.2014.10.011.

    Article  CAS  PubMed  Google Scholar 

  136. Cunha BA. No need for an initial test dose of meropenem or ertapenem in patients reporting anaphylactic reactions to penicillins. J Chemother. 2015;27(5):317–8. https://doi.org/10.1179/1973947814Y.0000000233.

    Article  CAS  PubMed  Google Scholar 

  137. Romano A, Viola M, Gueant-Rodriguez RM, Gaeta F, Pettinato R, Gueant JL. Imipenem in patients with immediate hypersensitivity to penicillins. N Engl J Med. 2006;354:2835–7.

    Article  CAS  PubMed  Google Scholar 

  138. • Romano A, Gaeta F, Valluzzi RL, Alonzi C, Maggioletti M, Zaffiro A, et al. Absence of cross-reactivity to carbapenems in patients with delayed hypersensitivity to penicillins. Allergy. 2013;68:1618–21. This study demonstrates the tolerability of imipenem/cilastatin, meropenem, and ertapenem in 204 subjects with a T cell mediated hypersensitivity to penicillins.

    Article  CAS  PubMed  Google Scholar 

  139. •• Kula B, Djordjevic G, Robinson JL. A systematic review: can one prescribe carbapenems to patients with IgE-mediated allergy to penicillins or cephalosporins? Clin Infect Dis. 2014;59:1113–22. A metaanalysis of penicillin and carbapenem cross reactivity studies.

    Article  CAS  PubMed  Google Scholar 

  140. Jensen T, Pedersen S, Hoiby N. Aztreonam for cystic fibrosis patients who are hypersensitive to other beta-lactams. Rev. Infect Dis. 1991;13:S594–7.

    Article  Google Scholar 

  141. Patriarca G, Schiavino D, Lombardo C, Altomonte G, De Cinti M, Buonomo A, et al. Tolerability of aztreonam in patients with IgE-mediated hypersensitivity to beta-lactams. Int J Immunopathol Pharmacol. 2008;21(2):375–9.

    Article  CAS  PubMed  Google Scholar 

  142. Pérez Pimiento A, Gómez Martínez M, Mínguez Mena A, Trampal González A, de Paz Arranz S, Rodríguez Mosquera M. Aztreonam and ceftazidime: evidence of in vivo cross allergenicity. Allergy. 1998;53(6):624–5.

    Article  PubMed  Google Scholar 

  143. Moss RB. Sensitization to aztreonam and crossreactivity with other beta-lactam antibiotics in high risk patients with cystic fibrosis. J Allergy Clin Immunol. 1991;87:78–88.

    Article  CAS  PubMed  Google Scholar 

  144. Blanca-Lopez N, Andreu I, Torres Jaen MJ. Hypersensitivity reactions to quinolones. Curr Opin Allergy Clin Immunol. 2011;11:285–91.

    Article  CAS  PubMed  Google Scholar 

  145. Miller MS, Gaido F, Rourk MH Jr, Spock A. Anaphylactoid reactions to ciprofloxacin in cystic fibrosis patients. Pediatr Infect Dis J. 1991;10(2):164–5.

    Article  CAS  PubMed  Google Scholar 

  146. Venturini Diaz M, Lobera Labairu T, del Pozo Gil MD, Blasco Sarramian A, Gonzalez Mahave I. vivo diagnostic tests in adverse reactions to quinolones. J Investig Allergol Clin Immunol. 2007;17:393–8.

    CAS  PubMed  Google Scholar 

  147. Seitz CS, Brocker EB, Trautmann A. Diagnostic testing in suspected fluoroquinolone hypersensitivity. Clin Exp Allergy. 2009;39:1738–45.

    Article  CAS  PubMed  Google Scholar 

  148. Demir S, Gelincik A, Akdeniz N, Aktas-Cetin E, Olgac M, Unal D, et al. Usefulness of in vivo and in vitro diagnostic tests in the diagnosis of hypersensitivity reactions to quinolones and in the evaluation of cross-reactivity: a comprehensive study including the latest quinolone gemifloxacin. Allergy Asthma Immunol Res. 2017;9(4):347–59. https://doi.org/10.4168/aair.2017.9.4.347.

    Article  PubMed  PubMed Central  Google Scholar 

  149. Araújo L, Macrolides DP. allergy. Curr Pharm Des. 2008;14:2840–62.

    Article  PubMed  Google Scholar 

  150. Benahmed S, Scaramuzza C, Messaad D, Sahla H, Demoly P. The accuracy of the diagnosis of suspected macrolide antibiotic hypersensitivity: results of a single-blinded trial. Allergy. 2004;59:1130–3.

    Article  CAS  PubMed  Google Scholar 

  151. Kruppa A, Scharffetter-Kochanek K, Krieg T, Hunzelmann N. Immediate reaction to roxithromycin and prick test cross-sensitization to erythromycin and clarithromycin. Dermatology. 1998;196:335–6.

    Article  CAS  PubMed  Google Scholar 

  152. Swamy N, Laurie SA, Ruiz-Huidobro E, Khan DA. Successful clarithromycin desensitization in a multiple macrolide-allergic patient. Ann Allergy Asthma Immunol. 2010;105:489–90.

    Article  PubMed  Google Scholar 

  153. Ünal D, Demir S, Gelincik A, Olgaç M, Coşkun R, Çolakoğlu B, Büyüköztürk S. Diagnostic value of oral challenge testing in the diagnosis of macrolide hypersensitivity. J Allergy Clin Immunol Pract. 2017. pii: S2213-2198(17)30520–2. https://doi.org/10.1016/j.jaip.2017.06.036.

  154. Connolly M, McAdoo J, Bourke JF. Gentamicin-induced anaphylaxis. Ir J Med Sci. 2007;176:317–8.

    Article  CAS  PubMed  Google Scholar 

  155. Schretlen-Doherty J. Tobramycin-induced hypersensitivity reaction. Ann Pharmacother. 1995;29:704–6.

    Article  CAS  PubMed  Google Scholar 

  156. Bensaid B, Rozieres A, Nosbaum A, Nicolas JF, Berard F. Amikacin-induced drug reaction with eosinophilia and systemic symptoms syndrome: delayed skin test and ELISPOT assay results allow the identification of the culprit drug. J Allergy Clin Immunol. 2012;130:1413–4.

    Article  CAS  PubMed  Google Scholar 

  157. Liippo J, Lammintausta K. Positive patch test reactions to gentamicin show sensitization to aminoglycosides from topical therapies, bone cements, and from systemic medication. Contact Dermatitis. 2008;59:268–72.

    Article  CAS  PubMed  Google Scholar 

  158. Gehrig KA, Warshaw EM. Allergic contact dermatitis to topical antibiotics: epidemiology, responsible allergens, and management. J Am Acad Dermatol. 2008;58:1–21.

    Article  PubMed  Google Scholar 

  159. Förström L, Pirilä V, Pirilä L. Cross-sensitivity within the neomycin group of antibiotics. Acta Derm Venereol Suppl (Stockh). 1979;59(85):67–9.

    Google Scholar 

  160. Earl HS, Sullivan TJ. Acute desensitization of a patient with cystic fibrosis allergic to both beta-lactam and aminoglycoside antibiotics. J Allergy Clin Immunol. 1987;79(3):477–83.

    Article  CAS  PubMed  Google Scholar 

  161. Myers AL, Gaedigk A, Dai H, James LP, Jones BL, Neville KA. Defining risk factors for red man syndrome in children and adults. Pediatr Infect Dis J. 2012;31(5):464–8. https://doi.org/10.1097/INF.0b013e31824e10d7.

    Article  PubMed  PubMed Central  Google Scholar 

  162. Anne S, Middleton E Jr, Reisman RE. Vancomycin anaphylaxis and successful desensitization. Ann Allergy. 1994;73:402–4.

    CAS  PubMed  Google Scholar 

  163. Asero R. Teicoplanin-induced anaphylaxis. Allergy. 2006;61:1370.

    Article  CAS  PubMed  Google Scholar 

  164. Bernedo N, Gonzalez I, Gastaminza G, Audicana M, Fernandez E, Munoz D. Positive patch test in vancomycin allergy. Contact Dermatitis. 2001;45:43.

    Article  CAS  PubMed  Google Scholar 

  165. Miyazu D, Kodama N, Yamashita D, Tanaka H, Inoue S, Imakyure O, et al. DRESS syndrome caused by cross-reactivity between vancomycin and subsequent teicoplanin administration: a case report. Am J Case Rep. 2016;17:625–31.

    Article  PubMed  PubMed Central  Google Scholar 

  166. Yang LP, Zhang AL, Wang DD, Ke HX, Cheng Q, Wang C. Stevens-Johnson syndrome induced by the cross-reactivity between teicoplanin and vancomycin. J Clin Pharm Ther. 2014;39(4):442–5. https://doi.org/10.1111/jcpt.12159.

    Article  CAS  PubMed  Google Scholar 

  167. •• Castells M. Rapid desensitization for hypersensitivity reactions to medications. Immunol Allergy Clin North Am. 2009;29:585–606. A pioneer and useful report for standardization and application of desensitization procedure.

    Article  PubMed  Google Scholar 

  168. •• Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, et al. Desensitization in delayed drug hypersensitivity reactions—an EAACI position paper of the Drug Allergy Interest Group. Allergy. 2013;68(7):844–52. https://doi.org/10.1111/all.12161. ENDA and the EAACI Drug Allergy Interest Group position paper.

    Article  CAS  PubMed  Google Scholar 

  169. Burrows JA, Toon M, Bell SC. Antibiotic desensitization in adults with cystic fibrosis. Respirology. 2003;8(3):359–64.

    Article  PubMed  Google Scholar 

  170. Whitaker P, Shaw N, Gooi J, Etherington C, Conway S, Peckham D. Rapid desensitization for non-immediate reactions in patients with cystic fibrosis. J Cyst Fibros. 2011;10(4):282–5.

    Article  CAS  PubMed  Google Scholar 

  171. Legere HJ, Palis RI, Rodriguez Bouza T, Uluer AZ, Castells MC. A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity. J Cyst Fibros. 2009;8(6):418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  172. Turvey S, Cronin B, Arnold A, Dioun A. Antibiotic desensitization for the allergic patient: 5 years of experience and practice. Ann Allergy Asthma Immunol. 2004;92:426–32.

    Article  PubMed  Google Scholar 

  173. •• Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, et al. General considerations on rapid desensitization for drug hypersensitivity—a consensus statement. Allergy. 2010;65:1357–66. ENDA and the EAACI Drug Allergy Interest Group position paper.

    Article  CAS  PubMed  Google Scholar 

  174. de Las Vecillas Sánchez L, Alenazy LA, Garcia-Neuer M, Castells MC. Drug hypersensitivity and desensitizations: mechanisms and new approaches. Int J Mol Sci. 2017 ;18(6). pii: E1316. https://doi.org/10.3390/ijms18061316.

  175. Breuer O, Cohen-Cymberknoh M, Armoni S, Kerem E, Shoseyov D. Continuousintravenous β-lactam antibiotics in cystic fibrosis patients with severe drug hypersensitivity. Ann Allergy Asthma Immunol. 2014;113(2):229–30. https://doi.org/10.1016/j.anai.2014.05.014.

    Article  CAS  PubMed  Google Scholar 

  176. Tosi MF, Konstan MW, Paschall VL. Rapid intravenous desensitization to colistin. Ann Allergy Asthma Immunol. 2012;109(5):361–2.

    Article  CAS  PubMed  Google Scholar 

  177. Lantner RR. Ciprofloxacin desensitization in a patient with cystic fibrosis. J Allergy Clin Immunol. 1995;96(6 Pt 1):1001–2.

    Article  CAS  PubMed  Google Scholar 

  178. Wilson DL, Owens RC Jr, Zuckerman JB. Successful meropenem desensitization in a patient with cystic fibrosis. Ann Pharmacother. 2003;37(10):1424–8.

    Article  PubMed  Google Scholar 

  179. Guglani L, Abdulhamid I, Ditouras J, Montejo J. Desensitization to inhaled aztreonam lysine in an allergic patient with cystic fibrosis using a novel approach. Ann Pharmacother. 2012;46(10):e25. https://doi.org/10.1345/aph.1R293.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Allergy and Immunology Department, Faculty of Medicine, Mersin University, Mersin, Turkey

    Semanur Kuyucu MD & Tugba Arıkoglu MD

Authors
  1. Semanur Kuyucu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tugba Arıkoglu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Semanur Kuyucu MD.

Ethics declarations

Conflict of Interest

Semanur Kuyucu declares that she has no conflict of interest. Tugba Arıkoglu declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Drug Allergy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuyucu, S., Arıkoglu, T. How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects. Curr Treat Options Allergy 5, 74–102 (2018). https://doi.org/10.1007/s40521-018-0152-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-018-0152-x

Keywords

Search

Navigation