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Allergies to non-betalactam antibiotics: a challenge in practice Abstract. The heterogeneous group of non-betalactam antibiotics can in part trigger very severe immunologically mediated hypersensitivity reactions. The risks are very differently distributed among the different representatives and a genetic predisposition to the development of Stevens-Johnson syndrome / toxic epidermal necrolysis or Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) can be observed. Individual patient groups are particularly frequently affected, including patients with HIV or cystic fibrosis. In this overview, the individual drug groups and corresponding risk situations as well as the available diagnostic means are discussed.

In theory, all medicines can elicit allergic reactions. However, there are large differences in the frequency and clinical presentation of these reactions. Antibiotics, antiepileptic agents and NSADs trigger allergic reactions most frequently. The risk of drug allergy and of a complicated clinical course depends on the individual degree of immune activation, the dose, duration of treatment, route of administration, patient sex as well as HLA-traits, which are increasingly being identified. This article presents the commonest types of immune-mediated drug-related hypersensitivity reactions and discusses red flags which are associated with a complicated clinical course.

Of the two most common obstructive lung diseases - bronchial asthma and chronic obstructive pulmonary disease (COPD) - asthma is clearly associated with a possible allergic background, therefore an allergological examination should be included in the work-up of this disease. COPD on the other hand is usually not expected to be linked with an atopic diathesis. Medical history, clinical manifestations, the presence of other atopic diseases, prick tests and measurement of specific IgE antibodies in the serum provide an indication of an allergic genesis of the obstructive pulmonary disease. Bronchial asthma can be roughly divided into an allergic phenotype (TH2-weighted) and a non-allergic phenotype (non-TH2-weighted). The TH2- weighted form leads to an infiltration of eosinophils into the bronchial wall allowing the possibility of a higher concentration of nitrogen oxide in the exhaled air (FeNO measurement) to be detected. In addition to the differentiation between allergic and non-allergic bronchial obstruction, an evaluation of symptoms associated with the workplace (work related asthma) must take place. Furthermore, questions about an intolerance to aspirin (aspirin - exacerbated respiratory disease) or exercise induced symptoms (exercise-induced asthma) should be asked. After a careful interpretation of clinical symptoms and findings in allergy tests, an allergologist can analyze the usefulness of a specific immunotherapy (SIT). For children who suffer from allergic rhinoconjunctivitis, an early SIT can prevent the shift to inflammation of the lower respiratory tract (asthma). Due to the overlapping pathophysiology and symptomatology between bronchial asthma and chronic obstructive pulmonary disease an allergological examination should be considered also in COPD patients.

Allergic rhinoconjunctivits and asthma are frequent diseases. About one in ten asthma cases is caused by an occupational hazard, either by an allergic or a non-immunologic mechanism. Primary or secondary preventive measures should be able to prevent these cases. Often, occupational rhinitis precedes the development of occupational asthma. Important causative agents are flours, plant and enzyme powders, laboratory animals, latex, isocyanates and hardeners, epoxy resins, acrylates, formaldehyde and welding fumes. Early diagnosis and the installation of protective measures are decisive for the prognosis of occupational respiratory disease.