Allergy to beta-lactams in pediatrics: a practical approach.
OBJECTIVE
To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics.


METHODS
Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts.


RESULTS
Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10% of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs' four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95%) and minor determinants (5%). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95% of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy.


CONCLUSIONS
The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.
Rosário
Nelson A
NA
Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil. nelson.rosario@ufpr.br
Grumach
Anete Sevciovic
AS
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D002511:Cephalosporins / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced*; D010406:Penicillins / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins