Clinical presentation and time course in hypersensitivity reactions to β-lactams
Article first published online: 6 JUL 2007
Volume 62, Issue 8, pages 872–876, August 2007
How to Cite
Bousquet, P. J., Kvedariene, V., Co-Minh, H.-B., Martins, P., Rongier, M., Arnoux, B. and Demoly, P. (2007), Clinical presentation and time course in hypersensitivity reactions to β-lactams. Allergy, 62: 872–876. doi: 10.1111/j.1398-9995.2007.01463.x
- Issue published online: 6 JUL 2007
- Article first published online: 6 JUL 2007
- Accepted for publication 11 May 2007
- drug allergy and hypersensitivity database;
- drug hypersensitivity;
- immediate reactions
Background: β-lactam hypersensitivity reactions are classified as immediate or nonimmediate. Diagnosis is usually based upon skin tests and provocation challenges.
Objective: The time course of the reactions in proven β-lactam hypersensitivities was studied and then correlated with the symptoms to determine the relationship between the clinical presentations and the time course.
Method: All of the patients who consulted between 1996 and 2004 for a suspected β-lactam hypersensitivity reaction were studied. Two hundred and ten patients with a proven hypersensitivity reaction diagnosed according to the European Network on Drug Allergy were included in the present study.
Results: Of the patients, 36.7% had urticaria as a single symptom, 19.1% anaphylaxis without shock, 17.6% anaphylactic shock and 19.1% maculopapular exanthema. Anaphylactic shock and anaphylaxis mostly occurred within 1 h after drug administration. Exanthema mainly occurred after 24 h. Urticaria as a single symptom occurred at any time. A firm diagnosis was determined using immediate-reading skin prick (10.0%) and intradermal tests (38.1%), late-reading skin tests (19.1%) or provocation tests (32.9%).
Conclusion and clinical implication: Depending on the time course of the reaction, three clinical groups were identified: anaphylaxis and anaphylactic shock (immediate reaction); maculopapular exanthema (late reaction) as well as urticaria (immediate and late reaction).