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Severe IgE-mediated allergic reactions to penicillins are rare but might be fatal. Because some studies demonstrated a high risk of cross-sensitivity to cephalosporins and carbapenems it has been recommended to avoid these antibiotics in patients with suspected hypersensitivity to penicillins. However, recent studies and analyses conclude that the risk of cross-reactivity was overestimated in the earlier studies and that it is in fact very low for parenteral cephalosporins and perhaps even negligible for carbapenems. The new knowledge has implications for the choice of therapy for bacterial infections in patients with a history of penicillin hypersensitivity, because alternative antibiotic regimens are often inferior to beta-lactam antibiotics. The aim of the present review is to present existing knowledge on cross-sensitivity between beta-lactams, as well as to discuss the management of patients with suspected allergic reactions to these antibiotics.

A history of thyroidal disease in a pregnant mother requires special attention. Untreated, or not adequately treated, hypothyreosis in a pregnant mother is likely to affect the neurological development of the fetus negatively. The authors refer the discussion on the need for screening for hypothyroidism in early pregnancy, but stress the need for everybody dealing with these patients (general practitioners, midwives, gynecologists, pediatricians and endocrinologists), to recognize women at risk and inform their patients on the need of careful monitoring of thyroid supplementation in case of pregnancy. On the other hand, women with Graves' disease should be carefully assessed for the presence of TRAK-antibodies, and be subject to specialist maternal care. Their babies risk neonatal thyreotoxicosis and need careful attention.

Primary hyperparathyroidism is a common endocrine disease particularly prevalent among elderly women. A majority of these patients diagnosed today are mildly hypercalcaemic, and many seem to lack manifest symptoms or complications. In such cases, conservative follow-up rather than parathyroid surgery may be suggested. However, long-term follow-up may entail costly investigations and be difficult to accomplish. Moreover, conservative follow-up is associated with a risk of subsequent complications or even premature death due to cardiovascular disorders. A Scandinavian multicentre study has been initiated to assess survival, morbidity and quality of life in surgically vs. conservatively treated patients.