Journal
CLINICAL AND EXPERIMENTAL ALLERGY
Volume 46, Issue 2, Pages 264-274Publisher
WILEY
DOI: 10.1111/cea.12689
Keywords
-
Categories
Funding
- Institute of Health 'Carlos III' of the Ministry of Economy and Competitiveness
- European Regional Development Fund (ERDF) [PI12/02529, PI15/01206, CP15/00103, CTS-06603]
- Red de Reacciones Adversas a Alergenos y Farmacos [RD12/0013/0001, RD12/0013/0003]
- Andalusian Regional Ministry Health [PI-0699-2011, PI-0179-2014, C-0044-2012 SAS 2013]
- Merck-Serono Research Grant from Fundacion Salud
- Ministry of Economy and Competitiveness
- European Social Fund (ESF) [CP15/00103, RYC-2013-13138]
Ask authors/readers for more resources
Betalactam (BL) antibiotics are the drugs most frequently involved in IgE-mediated reactions. The culprit BL varies according to consumption patterns, with amoxicillin (AX) more prevalent in Southern Europe and penicillin V in Scandinavian countries. Nowadays, the combination of AX and clavulanic acid (CLV) is the most highly consumed BL containing medicine worldwide. Both BLs, AX and CLV, can independently be involved in reactions, which poses a diagnostic challenge. In patients with immediate allergic reactions to AX, two patterns of responses have been described, those responding to benzylpenicillin (cross-reactors) and those selective to AX. In addition, selective reactions to CLV account for around 30% of allergic reactions to the combination AX-CLV. These patterns of IgE recognition could be related to differences in the haptenation process, in the immunological response, or in the BL involved in the first sensitization. In this regard, patients with selective responses to CLV are generally younger than those allergic to AX or benzylpenicillin. So far, no evidence of cross-reactivity between CLV and other BLs has been reported. This shows the importance of an accurate diagnosis of CLV allergy, as patients with selective reactions to CLV could take other BLs including AX. Diagnosis can be performed invivo and invitro, although no immunoassay currently exists. Research regarding the CLV antigenic determinants and protein conjugates is essential to improve diagnosis. BLs need to covalently bind to a carrier protein to be immunogenic. The antigenic determinant of AX is the amoxicilloyl amide, but CLV leads to unstable structures, many of which are unknown. Moreover, the nature of the BL-protein conjugates plays an important role in IgE recognition. This review aims to summarize current knowledge on the immunochemistry, diagnostic approaches as well as chemical and proteomic studies for both AX and CLV.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available