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T Lymphocytes as Tools in Diagnostics and Immunotoxicology pp 165–184Cite as

Hypersensitivity Reactions to Beta-lactams

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Part of the book series: Experientia Supplementum ((EXS,volume 104))

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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Abbreviations

AGEP:

Acute generalized exanthematous pustulosis

APC:

Antigen-presenting cells

AX:

Amoxicillin

BAT:

Basophil activation test

BLs:

Beta-lactam antibiotics

BP:

Benzylpenicillin

BPO:

Benzylpenicilloyl

CLA:

Cutaneous lymphocyte antigen

CPO:

Cephalosporoyl

DC:

Dendritic cells

DIHS:

Drug-induced hypersensitivity syndrome

DPT:

Drug provocation test

DRESS:

Drug hypersensitivity syndrome with eosinophilia and systemic symptoms

FDE:

Fixed drug eruption

LTT:

Lymphocyte transformation test

MDM:

Minor determinants mixture

MPE:

Maculopapular exanthema

PLL:

Poly-l-lysine

PPL:

Benzylpenicilloyl-poly-l-lysine

RAST:

Radioallergosorbent test

SJS:

Stevens–Johnson syndrome

TEN:

Toxic epidermal necrolysis

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Conflict of Interest

None of the authors have any conflict of interest nor have they received any money for the present study. Research is part of their daily activities. All the authors had full access to all the data and can take responsibility for the integrity of the data and the accuracy of the data analysis. The study was funded by FIS-Thematic Networks and Co-operative Research Centres (RIRAAF/RD07/0064), Junta de Andalucia (CTS 06603, PI-0545-2010), and FIS (09/01768, PS09/00966).

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Authors and Affiliations

  1. Allergy Service, pabellón 6, primera planta, IBIMA, Carlos Haya Hospital (Pabellon C), Plaza del Hospital Civil, 29009, Malaga, Spain

    Maria J. Torres & Miguel Blanca

  2. Allergy Research laboratory, IBIMA, Carlos Haya Hospital, Malaga, Spain

    Cristobalina Mayorga

  3. Allergy Service, Infanta Leonor Hospital, Madrid, Spain

    Natalia Blanca-López

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  1. Maria J. Torres
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  2. Cristobalina Mayorga
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  3. Natalia Blanca-López
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  4. Miguel Blanca
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Correspondence to Maria J. Torres .

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Editors and Affiliations

  1. Department of Dermatology and Venereology, University Medical Center Freiburg, Freiburg, Germany

    Stefan F. Martin

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Torres, M.J., Mayorga, C., Blanca-López, N., Blanca, M. (2014). Hypersensitivity Reactions to Beta-lactams. In: Martin, S. (eds) T Lymphocytes as Tools in Diagnostics and Immunotoxicology. Experientia Supplementum, vol 104. Springer, Basel. https://doi.org/10.1007/978-3-0348-0726-5_11

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