Antibiotic desensitization in adults with cystic fibrosis

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Respirology

Volume 8 Issue 3 Page 359 - September 2003

doi:10.1046/j.1440-1843.2003.00461.x

ORIGINAL ARTICLE

Antibiotic desensitization in adults with cystic fibrosis

Judith A. BURROWS1,2, TOON2 AND C. BELL1,3

Objective: Allergic reactions to antibiotics occur in up to 30% of

patients with cystic fibrosis (CF). Repeated antibiotic exposure and

immune hyper-responsiveness increase the risk of allergic reactions

and may limit antibiotic choice. Desensitization may allow the

successful administration of an antibiotic despite previous allergy.

We aimed to determine the success of antibiotic desensitization in

patients with CF in an adult CF unit over a 7-year period.

Methodology: A retrospective medical record review was performed on

the 19 patients who had undergone antibiotic desensitization

procedures. Data collected included drug allergy and intolerance

profiles, nature of allergies, and the outcome of desensitization

procedures. Desensitization procedures were performed in a ward

setting according to published methods.

Results: Nineteen patients (13 females) reported 62 drug allergies

with a mean of 3.3 per patient. Of the 71 desensitization procedures

undergone by this group, 54 (76%) were successful. Fifteen of the 19

patients were allergic to two or more beta-lactam antibiotics. Over

half of the patients were desensitized to more than one antibiotic.

Nine different antibiotics were used in 31 different patient/drug

combinations. A successful outcome was achieved in 18/31 (58%)

combinations, with three requiring treatment for mild allergic

reactions. Allergic reactions caused drug cessation in a total of 19

patient/drug combinations (three after initial successful

desensitization and full courses of antibiotics). Over 50% of these

reactions occurred on day 1. Desensitization failures were more

common in patients with well-documented allergic reactions to a

specific drug.

Conclusion: This study demonstrates that multiple antibiotic

allergies are common in adults with CF. Cross-reactivity between beta-

lactam antibiotics may limit antibiotic choice for the treatment of

pulmonary exacerbations. Antibiotic desensitization allows safe and

successful treatment in the ward setting of many patients with

previous allergies to an antibiotic. In many patients symptoms of

allergy still occur and result in cessation of the antibiotics. Use

of corticosteroids and antihistamines may improve the success rate of

desensitization procedures.