PMID- 25968421
OWN - NLM
STAT- MEDLINE
DCOM- 20150904
LR  - 20150626
IS  - 1423-0097 (Electronic)
IS  - 1018-2438 (Linking)
VI  - 166
IP  - 4
DP  - 2015
TI  - Anti-Amoxicillin Immunoglobulin E, Histamine-2 Receptor Antagonist Therapy and 
      Mast Cell Activation Syndrome Are Risk Factors for Amoxicillin Anaphylaxis.
PG  - 280-6
LID - 10.1159/000380950 [doi]
AB  - BACKGROUND: beta-Lactam antibiotics (mainly amoxicillin, AX) are the drugs that most 
      frequently induce systemic drug allergy reactions. OBJECTIVE: We attempted to 
      identify the risk factors associated with systemic reactions to AX. METHODS: All 
      patients who were referred to our department for suspected hypersensitivity 
      reactions to AX over a 6-month period were evaluated for anti-AX immunoglobulin E 
      (IgE) levels and skin-test positivity for beta-lactams. Age, sex, concomitant 
      diseases, therapies, total IgE, serum tryptase levels and signs and symptoms 
      suggesting mast cell activation syndrome (MCAS) were analyzed in relation to the 
      severity of the reaction in accordance with the Mueller classification. RESULTS: 
      Sixty-seven patients were selected: 39 with mild reactions such as cutaneous or 
      gastrointestinal symptoms (grades I and II) and 28 with severe systemic reactions 
      (grades III and IV). Anti-AX IgE levels and total IgE were significantly higher 
      in severe reactions than in mild ones (p < 0.00005, p = 0.0037). Treatment with 
      histamine-2 receptor antagonists (anti-H2) was significantly related to severe 
      reactions (p = 0.007). No significant correlations were found between the 
      severity of the reactions and dyslipidemia or levels of angiotensin-converting 
      enzyme and tryptase. CONCLUSION: Anti-AX IgE levels were the most significant 
      immunological parameter distinguishing patients who presented with severe 
      reactions to AX and those with mild reactions. Higher values of total IgE, the 
      use of gastroprotective drugs and signs and symptoms suggesting an MCAS 
      significantly increased the odds ratio of having a severe reaction. The risk of 
      serious adverse reactions to AX increased in older patients and in males, but 
      this trend was not significant.
FAU - Pastorello, Elide Anna
AU  - Pastorello EA
AD  - Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy.
FAU - Stafylaraki, Chrysi
AU  - Stafylaraki C
FAU - Mirone, Corrado
AU  - Mirone C
FAU - Preziosi, Donatella
AU  - Preziosi D
FAU - Aversano, Maria Gloria
AU  - Aversano MG
FAU - Mascheri, Ambra
AU  - Mascheri A
FAU - Losappio, Laura Michelina
AU  - Losappio LM
FAU - Ortolani, Valeria
AU  - Ortolani V
FAU - Nichelatti, Michele
AU  - Nichelatti M
FAU - Farioli, Laura
AU  - Farioli L
LA  - eng
PT  - Journal Article
DEP - 20150506
PL  - Switzerland
TA  - Int Arch Allergy Immunol
JT  - International archives of allergy and immunology
JID - 9211652
RN  - 0 (Histamine H2 Antagonists)
RN  - 37341-29-0 (Immunoglobulin E)
RN  - 804826J2HU (Amoxicillin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Amoxicillin/*adverse effects/immunology
MH  - Anaphylaxis/chemically induced/*immunology
MH  - Drug Hypersensitivity/blood/*immunology
MH  - Female
MH  - Histamine H2 Antagonists/adverse effects/immunology
MH  - Humans
MH  - Immunoglobulin E/*blood
MH  - Male
MH  - Mast Cells/*immunology
MH  - Middle Aged
MH  - Risk Factors
MH  - Young Adult
EDAT- 2015/05/15 06:00
MHDA- 2015/09/05 06:00
CRDT- 2015/05/14 06:00
PHST- 2014/06/20 00:00 [received]
PHST- 2015/02/16 00:00 [accepted]
PHST- 2015/05/14 06:00 [entrez]
PHST- 2015/05/15 06:00 [pubmed]
PHST- 2015/09/05 06:00 [medline]
AID - 000380950 [pii]
AID - 10.1159/000380950 [doi]
PST - ppublish
SO  - Int Arch Allergy Immunol. 2015;166(4):280-6. doi: 10.1159/000380950. Epub 2015 
      May 6.