Drug allergy to antibiotics. Part I. Prevalence, mechanisms of development, clinic, treatment, prevention

Drug allergy is a part of adverse reactions to drugs and refers to those pathological reactions that are unpredictable, do not depend on the dose of drugs (type B adverse reactions) and are based on immunological mechanisms. It is an extremely heterogeneous phenomenon characterized by etiological, pathogenetic and clinical polymorphism. Drug allergy occurs in 2% of cases among the general population, in 5–15% of cases among the categories that are often and long-term treated, and in medical workers — up to 30%. Most often, drug allergies are caused by antibiotics, among which β-lactams are the undisputed leaders. Other antibiotics (macrolides, quinolones, tetracyclines, etc.) cause drug allergies much less often. The problem of cross-reactivity between antibiotics with similar antigenic determinants is especially relevant for penicillins and cephalosporins of the 1st generation, as well as for the group of aminoglycosides. This problem is not relevant for penicillins, monobactams and carbapenems and is not sufficiently studied for macrolides and quinolones. Clinical manifestations of drug allergy depend on the mechanisms of development of hypersensitivity reactions to antibiotics. It is necessary to collect the pharmacological history of patients before prescribing them any medicines, especially antibiotics. The doctor should carefully keep medical records at all stages of the treatment of a patient with adverse reactions to drugs, and the optimal solution for a doctor in the presence of an allergic reaction in the anamnesis should be the appointment of an alternative drug with similar pharmacological properties, but a different chemical structure. A diagnosis of drug allergy should not be made only on the basis of laboratory test data, a large part of which is not validated in Ukraine, condemning patients to a lifelong label of such a diagnosis and depriving them of the opportunity to be effectively treated with drugs that are not causally significant.

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