Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

Mario Sánchez-Borges; Bernard Thong; Miguel Blanca; Luis Felipe Chiaverini Ensina; Sandra González-Díaz; Paul A Greenberger; Edgardo Jares; Young-Koo Jee; Luciana Kase-Tanno; David Khan; Jung-Won Park; Werner Pichler; Antonino Romano; Maria José Torres Jaén

doi:10.1186/1939-4551-6-18

World Allergy Organization Journal

Table 3 Adverse reactions to non beta-lactam antimicrobials: clinical picture and diagnostic tests*

From: Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

Drugs	Clinical manifestations	Diagnostic tests	Drug concentrations
Aminoglycosides	CD, U, MPE, FDE, TEN, DIHS, ANA	PT	1-20%
Aminoglycosides	CD, U, MPE, FDE, TEN, DIHS, ANA	STs	0.1 ng/mL-20 mg/mL
Chloramphenicol	ANA, fever, U, AE, MPE, AGEP, CD, bullous eruption, EM, FDE, SJS, TEN, bronchospasm, aplastic anemia	STs	-
Chloramphenicol		PT	1%
Clindamycin	MPE, ANA, U, AE, FDE, bullous eruptions, AGEP, Sweet’s syndrome, SJS, DIHS	OPT	-
Clindamycin		PT	10%
Dapsone	Methemoglobinemia, agranulocytosis	Methemoglobin measurement	-
Ethambutol	Skin rash, ED, U, AE, EM, SJS, TEN, blood eosinophilia, pulmonary infiltrates, hepatitis, vomiting, thrombocytopenia, flu-like syndrome, arthralgia, neuropsychiatric symptoms, optic neuritis	PT	10-50%
Isoniazid	MPE, lichenoid rash, flushing, DIHS, SJS, pruritus, drug fever, peripheral neuropathy, hepatitis	Graded challenge	-
Macrolides	U, AE, RC, ANA, MPE, CD, FDE, TEN	STs	Erythromycin 0.05 mg/mL
			Azithromycin 0.01 mg/mL
			Roxythromycin 50 mg/mL
			Clarithromycin 0.5 mg/mL
		PT	10%
		OPT	-
Pyrazinamide	Flushing, itchy rash, ANA, hepatitis	STs	500 mg/mL
Quinolones	U, ANA, MPE, FDE, photoallergy, AGEP, SJS, TEN	STs	Levofloxacin 5 mg/mL
			Ciprofloxacin 2 mg/mL
			Moxifloxacin 1.6 mg/mL
		OPT
Rifampicin	Flushing, flu-like syndrome, MPE, pemphigus, lupus erythematosus, SJS, TEN, ANA, thrombocytopenia, nephrotoxicity, hepatitis, hemolytic anemia	STs	1: 10000
Streptomycin	Skin rash, ANA, ototoxicity, nephrotoxicity, MPE, U, ED, SJS, DIHS	PT	20%
Sulphamethoxazole	Nausea, haemopoietic disorders, porphyria, ANA, haemolyitc anemia, MPE, SJS, TEN, DIHS	STs	80 mg/mL
		PT	10%
		LTT
Telithromycin	Hepatotoxicity, U, AE, ANA, TEN	OPT	-
Tetracyclines	FDE, DIHS, TEN, hepatitis, pneumonitis, ANA, phototoxic and photallergic reactions	STs	Doxycicline :prick 20 mg/mL; id: 2 mg/mL
Tetracyclines		PT	5%
Vancomycin	RMS, ANA, SJS, ED, TEN, FDE, vasculitis, DIHS, AGEP, linear IgA bullous dermatosis, nephropathy	STs	0.1 mg/mL
		PT	0.005%

*Concentrations given are drawn from the literature. Many of those have not been validated.
Legend: ANA: anaphylaxis; AE: angioedema; CD: contact dermatitis; DIHS: drug-induced hypersensitivity syndrome (DRESS); EM: erythema multiforme; ED: exfoliative dermatitis; FDE: fixed drug eruption; LTT: lymphocyte transformation test; MPE: maculopapular exanthema; OPT: oral provocation test; PT: patch tests; RMS: red man syndrome; RC: rhinoconjunctivitis; SJS: Stevens-Johnson syndrome; STs: skin tests; TEN: toxic epidermal necrolysis; U: urticaria.

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