title: Allergic reactions to antimicrobial agents: a review of reactions to drugs not in the beta lactam antibiotic class.
abstract: Allergic reactions to antimicrobial drugs are common causes of morbidity but rarely of death. Despite the lack of proven immunodiagnostic tests for reactions to the non-beta-lactam drugs, the agents that cause reactions usually can be identified by analysis of their propensity to cause reactions, temporal relationships of exposure to reactions, and remission of reactions when the drugs are discontinued. Measurements of plasma histamine levels, high-molecular-weight neutrophil chemotactic factor, and heparin-like activity and of urinary histamine and prostaglandin D2 metabolites should help clarify the role of mast cell mediator release in the various forms of these reactions. Measurements of C3a, C4a, and C5a, in biologic fluids should facilitate analysis of the contributions of complement activation to the reactions observed. Assessment of these pathophysiologic parameters should provide a more rational basis for the selection of specific pharmacologic interventions to suppress allergic reactions. If no alternative drugs are available, infected patients who are allergic often can be gradually desensitized with the agents to which they are allergic. While much important work remains to be completed, current approaches can minimize the morbidity and mortality rates associated with allergic reactions to antimicrobial agents.
mesh_terms: D000900:Anti-Bacterial Agents / Q000276:immunology*; D003888:Desensitization, Immunologic; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology; D012306:Risk; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams