In patients with beta-lactam allergy, the minor antigenic determinants generate IgE-specific responses associated with type I allergy. The major determinant is penicilloyl, and the minor determinants include penicillin, penicilloate, and penilloate. When a beta-lactam is administered, the common core ring structure is metabolized into major and minor antigenic determinants.
* Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) or drug rash with eosinophilia and systemic symptoms (DRESS).īecause all penicillin antibiotics share a similar beta-lactam core ring structure, one must consider the potential for cross-allergenicity between different agents in the beta-lactam class. Type I reactions are immediate in nature and may result in symptoms such as urticaria, flushing, dyspnea, bronchospasm, angioedema, hypotension, tachycardia, altered mental status or gastrointestinal upset. In response to histamine and other inflammatory mediators, there is an increase in vascular permeability and a widespread constriction of smooth muscle, which can ultimately lead to anaphylactic shock. This interaction causes the cells to degranulate and release a potent mixture of histamine and inflammatory mediators. Type I hypersensitivity reactions are triggered by the interaction of an allergen with allergen-specific IgE bound to mast cells, basophils, and eosinophils. Of the four reaction types described in Table 1, penicillin allergies most often present as type I or type IV hypersensitivity reactions. Pathophysiologyīeta-lactam allergies are hypersensitivity reactions that are the consequence of an adaptive immune response.
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