Patients Taking Amoxicillin-Clavulanic Can Become Simultaneously Sensitized to Both Drugs.
BACKGROUND
Patients can react to amoxicillin (AX) and clavulanic acid (CLV) taken in combination because of selective reactions to either drug. However, scant information exists concerning patients who react simultaneously to both compounds.


OBJECTIVE
To analyze the mechanisms involved in 4 patients who developed allergic reactions to AX-CLV administration (3 with immediate IgE-mediated reaction and 1 with nonimmediate T-cell-mediated reaction) and who responded specifically to both AX and CLV.


METHODS
Skin tests with benzylpenicillin (BP), AX, and CLV were done and, if necessary, drug provocation tests with BP/penicillin V, AX, and AX-CLV were carried out. In immediate reactors, serum specific IgE to benzylpenicilloyl and amoxicilloyl was determined by using the CAP-FEIA system (Pharmacia Diagnostics, Uppsala, Sweden), and basophil activation test to BP, AX, CLV, and AX-CLV was done. In nonimmediate reactors, immunohistochemistry of skin biopsy and analysis of dendritic cell maturation and T-cell-specific response to BP, AX, CLV, and AX-CLV at both acute and resolution phases of the reaction were conducted.


RESULTS
All patients with immediate reactions (N = 3) had good tolerance to BP and penicillin V. Two cases also had specific IgE to AX and all had a basophil activation test positive to AX, CLV, and AX-CLV. The patient with a nonimmediate reaction exhibited dendritic cell and T-lymphocyte responses specific to both AX and CLV. Finally, the analysis of the cells infiltrating the skin and peripheral blood during the acute phase indicated a TH1 pattern response.


CONCLUSIONS
Our study provides evidence that reactions to both AX and CLV can appear in the same patient.
Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
María
M
Salas
Allergy Unit, Cruz Roja Hospital, Madrid, Spain.
Jose Julio
JJ
Laguna
Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Inmaculada
I
Doña
Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Esther
E
Barrionuevo
Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Rubén
R
Fernandez-Santamaría
Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Adriana
A
Ariza
Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain; Department of Organic Chemistry, University of Málaga, IBIMA, Málaga, Spain.
Ezequiel
E
Perez-Inestrosa
Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain; Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Cristobalina
C
Mayorga
Research Laboratory, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain.
Tahia Diana
TD
Fernández
Allergy Unit, IBIMA-Regional University Hospital of Málaga-UMA, Málaga, Spain; Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain. Electronic address: mjtorresj@ibima.eu.
María José
MJ
Torres
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000658:Amoxicillin / Q000276:immunology* / Q000627:therapeutic use; D001706:Biopsy; D002478:Cells, Cultured; D019818:Clavulanic Acid / Q000276:immunology* / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology / Q000517:prevention & control*; D006969:Hypersensitivity, Immediate / Q000209:etiology / Q000517:prevention & control*; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D018417:Th1 Cells / Q000276:immunology*
D000485:Allergens; D019818:Clavulanic Acid; D007073:Immunoglobulin E; D000658:Amoxicillin
Allergy; Amoxicillin; Clavulanic acid; IgE; T cells