title: Evolution of diagnostic approaches in betalactam hypersensitivity.
abstract: Betalactams are the most widely used drugs against infections and the primary cause of antibiotic hypersensitivity reactions. Reaction patterns for different betalactams have been changing in accordance with consumption trends, and vary among countries. As a consequence, in vivo and in vitro tests have had to change with to keep up with new tendencies. Areas covered: This review is focused on advances in betalactam hypersensitivity diagnosis. Changes in in vivo methods have been limited to the inclusion of new haptens. In contrast, major progress has been achieved for in vitro tests since the 1960s, from the first description of immunoassays, the basophil activation test and the lymphocyte transformation test, to the more sophisticated assays developed in last years. Expert commentary: Issues with diagnosis are related to test sensitivity. In vivo tests show higher sensitivity, however they can be risky, especially in severe and life-threatening reactions. Therefore, we believe that in vitro tests should be the preferred method. Current efforts are under way to enhance their sensitivity. Only multidisciplinary approaches involving immunology, proteomics, nanotechnology and chemistry can help us to fully understand conjugate structures and mechanisms involved in hypersensitivity reactions to betalactams, and consequently lead to advances in in vitro methods.
authors.affiliation: a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Tahia D
authors.initials: TD
authors.lastname: Fernandez
authors.affiliation: a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.|b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Cristobalina
authors.initials: C
authors.lastname: Mayorga
authors.affiliation: b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Salas
authors.affiliation: b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Barrionuevo
authors.affiliation: b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Posadas
authors.affiliation: a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ariza
authors.affiliation: c Allergy Unit , Hospital de la Cruz Roja , Madrid , Spain.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Laguna
authors.affiliation: d Allergy Service , University Hospital of Salamanca , Salamanca , Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Moreno
authors.affiliation: b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.|e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Torres
authors.affiliation: b Allergy Unit , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Doña
authors.affiliation: a Research Laboratory , IBIMA - Regional University Hospital of Malaga - UMA , Málaga , Spain.|e Laboratory of Nanostructures for Diagnosing and Treatment of Allergic Diseases , Andalusian Center for Nanomedicine and Biotechnology - BIONAND , Málaga , Spain.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Montañez
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008213:Lymphocyte Activation; D036103:Nanotechnology / Q000379:methods; D040901:Proteomics / Q000379:methods; D047090:beta-Lactams / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: Basophil activation test; betalactam; drug allergy; drug provocation test; histamine release test; immunoassay; lymphocyte transformation test; skin test