18 Other studies provided evidence for a broader scope of BL hypersensitivity, reporting selective reactions to cephalosporins, 19, 20 monobactams, 21 and other BL. 2, 13, 14, 15, 16, 17 Based on these findings, the European Academy of Allergy and Clinical Immunology (EAACI) developed consensus-based guidelines for evaluating IR to BL.
These findings had a great impact on the evaluation of allergic reactions to BL, driving increased research interest on the topic in Europe 12, 13 and elsewhere, with studies reporting significant differences in the prevalence and clinical significance of these reactions. 10 Before then, evidence was scanty, with a limited number of studies reporting these reactions, 3, 9 though the door remained open to the possibility that the side chain of penicillins could contribute to inducing the response. Major changes were reported in the late 1980s and the early 1990s, when in vivo and in vitro studies demonstrated the relevance of the amoxicillin (AX) side chain in inducing selective immediate reactions (IR) 8, 9 and of aminopenicillins in non-immediate reactions (NIR). 1, 3 Modifications to chemical structures aimed at evading bacterial resistance, evolving patterns of consumption, and the genetic response contribute to this phenomenon.
1, 2 BL allergies have been changing over the past decades, with a growing body of evidence supporting the need to adapt guidelines to new observations. Beta-lactam (BL) antibiotics are the most frequently involved drugs in allergic drug reactions.
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