Allergy Asthma Immunol Res.  2017 Jul;9(4):288-298. 10.4168/aair.2017.9.4.288.

In Vitro Diagnostic Testing for Antibiotic Allergy

• Doña I
• Torres MJ
• Montañez
• Fernández TD

• KMID: 2378191
• DOI: http://doi.org/10.4168/aair.2017.9.4.288

Abstract

Allergy to antibiotics is an important worldwide problem, with an estimated prevalence of up to 10% of the population. Reaction patterns for different antibiotics have changed in accordance with consumption trends. Most of the allergic reactions to antibiotics have been reported for betalactams, followed by quinolones and macrolides and, to a lesser extent, to others, such as metronidazole clindamycin and sulfonamides. The diagnostic procedure includes a detailed clinical history, which is not always possible and can be unreliable. This is usually followed by in vivo, skin, and drug provocation tests. These are not recommended for severe, potentially lifethreaten reactions or for drugs that are known to produce a high rate of false positive results. Given the limitations of in vivo tests, in vitro test can be helpful for diagnosis, despite having suboptimal sensitivity. The most highly employed techniques for diagnosing immediate reactions to antibiotics are immunoassays and basophil activation tests, while lymphocyte transformation tests are more commonly used to diagnose non-immediate reactions. In this review, we describe different in vitro techniques employed to diagnose antibiotic allergy.

Keyword

Antibiotic; drug allergy; in vitro test

MeSH Terms

Anti-Bacterial Agents
Basophils
Clindamycin
Diagnosis
Diagnostic Tests, Routine*
Drug Hypersensitivity
Hypersensitivity*
Immunoassay
In Vitro Techniques*
Lymphocyte Activation
Macrolides
Metronidazole
Prevalence
Quinolones
Skin
Sulfonamides
Anti-Bacterial Agents
Clindamycin
Macrolides
Metronidazole
Quinolones
Sulfonamides

Figure

• 

  Fig. 1 Schematic representation of the determination of sIgE by immunoassays. During incubation with the patient's serum, antibiotic-PLL conjugate (coupled to a solid phase) is recognized by serum sIgE. The amount of bound sIgE is subsequently quantified using a secondary anti-human IgE antibody labeled with a detectable property, i.e., radioactivity (RAST) or fluorescence (ImmunoCAP). IgE, immunoglobulin E; sIgE, specific IgE; PLL, poly-L-lysine; RAST, radioallergosorbent test.

• 

  Fig. 2 Schematic representation of the basophil activation test. The antibiotic is recognized via IgE on the cellular surface. This process leads to the release of allergy mediators followed by the exposure of activation markers, which can be recognized by fluorochrome-labeled specific antibodies. This activation can be quantified using a flow cytometer. IgE, immunoglobulin E.

• 

  Fig. 3 Schematic representation of the flow cytometric lymphocyte transformation test. Lymphocytes are labeled with a fluorescent dye which accumulates in their cytoplasm. After antibiotic presentation, lymphocytes are activated and start to proliferate. This proliferation process leads to the sequential dilution of the dye which can be measured, so that quantified and successive cell generations can be visualized by flow cytometry.

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