Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis

Background An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. Objective To assess that the immediate hypersensitivity...

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Bibliographic Details
Published in:Allergy (Copenhagen) 2015-08, Vol.70 (8), p.1013-1019
Main Authors: Blanca‐Lopez, N., Perez‐Alzate, D., Ruano, F., Garcimartin, M., Torre, V., Mayorga, C., Somoza, M. L., Perkins, J., Blanca, M., Canto, M. G., Torres, M. J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Distribution
Aged
Allergies
amoxicillin
Amoxicillin - adverse effects
Amoxicillin - immunology
Antibiotics
Chi-Square Distribution
clavulanic acid
Clavulanic Acid - adverse effects
Clavulanic Acid - immunology
Cohort Studies
cross‐reactivity
Drug Hypersensitivity - diagnosis
Drug Hypersensitivity - epidemiology
Drug Hypersensitivity - etiology
Female
Humans
Hypersensitivity, Immediate - diagnosis
Hypersensitivity, Immediate - epidemiology
Hypersensitivity, Immediate - etiology
immediate response
Incidence
Male
Middle Aged
Penicillin
Penicillin G - immunology
Prospective Studies
Risk Assessment
selective
Sex Distribution
Side effects
Skin Tests
Young Adult
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Summary:Background An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. Objective To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX. Methods Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure. Results Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX‐selective cases developed positive responses after re‐provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX. Discussion The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely.
ISSN:0105-4538
1398-9995
DOI:10.1111/all.12636