This is a tool to aid identifying which beta lactam antibiotics have high and low risk of cross reactivity
This document can only be used to evaluate the risk of cross reactivity between beta lactams in patients with type I IgE mediated hypersensitivity reactions. This does NOT apply to type II, III, and IV hypersensitivity reactions. Please see below for information on other types of hypersensitivity reactions and their management
Description: IgE mediated, immediate type hypersensitivity
Mediator: IgE antibodies
Onset: 0-1 hr
Clinical Reactions: Anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, pruritis
Management: Avoid offending agent and cross reacting agents
Description: Antibody dependent cytotoxicity
Mediator: IgG and IgM antibodies
Onset: >72 hr
Clinical Reactions: Hemolytic anemia, thrombocytopenia, neutropenia
Management: Drug specific, avoid offending agent
Description: Antibody complex mediated hypersensitivity
Mediator: Antigen-antibody complexes
Onset: >72 hr
Clinical Reactions: Serum sickness, vasculitis, drug fever, glomerulonephritis
Management: Avoid beta lactams, consult AMS or ID for alternative antibiotic
Description: Delayed type hypersensitivity
Mediator: T cells
Onset: >72 hr
Clinical Reactions: Contact dermatitis, some morbilliform reactions, severe exfoliative dermatoses (e.g. SJS/TEN), AGEP, DRESS/DiHS, interstitial nephritis, drug-induced hepatitis
Management: Avoid beta lactams, consult AMS or ID for alternative antibiotic
The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.
Adapted from the BC Women’s Hospital Antimicrobial Stewardship Program