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ALERGIA A LAS 
PENICILINAS 
Carolina Arango 
Sebastián Guerra 
Alejandro Montoya 
Valeria Rodríguez 
Sebastián Tamayo 
Est...
• Alergias medicamentosas: reacciones 
adversas relacionadas a una particular 
respuesta inmunológica del organismo, 
dosi...
Epidemiología 
• Penicilinas y cefalosporinas son los ATB 
más comunmente asociados con 
reacciones alérgicas. 
• Alergia ...
• Desde hace 70 años. 
(introducción de la 
penicilina) 
• Sólo poco porcentaje 
de pacientes que 
reportan una reacción 
...
• Uno de los ATB más usados en el mundo. 
• Reacciones alérgicas: 0.7% al 8%. 
• Anafilaxia: 0.004% - 0.015% de los casos....
• 6.2% de los pacientes hospitalizados 
refieren AA de alergia a la penicilina, pero 
sólo 5 – 20% presenta reacciones 
al...
• 1% con AP + Pruebas cutáneas positivas 
presentará luego de recibir penicilina, 
reacciones urticarianas aceleradas, y u...
• 97% y el 99% de los pacientes 
con AP + Pruebas negativas, 
tolera los Beta lactámicos sin 
riesgo de reacción inmediata...
• En pacientes con pruebas cutáneas 
positivas, el riesgo de una reacción 
alérgica es del 10% cuando no hay AP, y 
del 50...
CLASIFICACION, 
ESTRUCTURA QUIMICA Y 
MECANISMOS DE ACCION
CLASIFICACION 
• PENICILINAS 
• AMINOPENICILINAS 
• CEFALOSPORINAS 
• CEFAMICINAS 
• CARBAPENEMS 
• MONOBACTAMICOS 
• INHI...
Romano A, Warrington R. Antibiotic Allergy. Immunology 
and Allergy Clinics of North America. 2014;34(3):489-506.
ESTRUCTURA
MECANISMO DE ACCION 
• Inhiben la enzima DD-Transpeptidasa 
• Activación del sistema endógeno auto lítico
Efectos Adversos de Beta lactámicos 
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
R...
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
2011...
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
2011...
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
2011...
Gell y Coombs 
Chang C, MahmoodM, 
Teuber S, Gershwin M. 
Overview of Penicillin 
Allergy. Clinical Reviews in 
Allergy & ...
Stevens-Johnson y Necrolisis 
Epidérmica Toxica 
Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy....
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
2011...
Amoxicilina 
Chang C, MahmoodM, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immu...
Mecanismo 
Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunol...
Clínica 
Chang C, Mahmood M, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunol...
Factores de riesgo 
• Edad: 20 y 49 años. 
DHR son menos comunes en niños que en 
adultos. 
• Frecuencia y ruta de admini...
• Dosis: IV. 
• Síndrome de alergia a múltiples 
fármacos: reacciones alérgicas 
generadas por 2 o mas medicamentos. 
o Pa...
• Factores hereditarios: Evidencia limitada 
HLA-DRB (población china): alergia a la 
penicilina mediada por IgE. 
Niños...
• Exposiciones previas: 0,45% sin exposición 
previa y test cutáneo negativo, harán una 
reacción alérgica al recibir su p...
PRUEBA CUTANEA PARA 
ALERGIA A PENICILINA 
SPT - IDT
• INMEDIATA (igE): urticaria, angioedema, 
anafilaxia, broncoespasmo. 
• ACELERADA (igE): urticaria. 
• TARDIA(complejos i...
INDICACIONES 
• FLUSH. 
• URTICARIA. 
• ANGIOEDEMA. 
• ANAFILAXIA. 
• CONJUNTIVITIS. 
• RINITIS. 
• ASMA O BRONCOESPASMO.
CONTRAINDICACIONES 
• ENFERMEDADES AUTOINMUNES 
• REACCIONES EXFOLIATIVAS
TIEMPO PARA REALIZAR EL TEST 
• 6 semanas a 6 meses
PRUEBA 
• IDT Y SPT (PPL o penicilina) 
– 1. Realizar dilución. 
– 2. hacer primero SPT. 
– 3. subir la concentración de l...
FALSOS POSITIVOS 
- Paciente sensibilizado. 
- de granulación de mastocitos espontanea . 
- Alteración en la dilución. 
- ...
FALSOS NEGATIVOS 
– RAZONES TECNICAS: 
• Dilución inapropiada. 
• Penetración insuficiente. 
• Bloqueo del efecto por anti...
Manejo 
Chang C, Mahmood M, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunolo...
Chang C, Mahmood M, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
201...
Chang C, Mahmood M, Teuber S, Gershwin 
M. Overview of Penicillin Allergy. Clinical 
Reviews in Allergy & Immunology. 
201...
Reactividad cruzada con penicilina 
• Hasta un 25% de alérgicos a las 
cefalosporinas son alérgicos a la penicilina. 
• En...
• Estudios recientes han mostrado que la 
sensibilidad cruzada con cefalosporinas 
de tercera generación es menor. 
Chang ...
Pichichero ME. Use of selected cephalosporins in penicillin-allergic patients: a paradigm 
shift. Diagn Microbiol Infect D...
• Cualquier reacción 4,3% 
• Reacciones: probadas, sospechadas o posibles 
mediadas por IgE: 2,4% 
• Relacion de test cuta...
Test de dosis 
• Se realiza si el resultado de la prueba 
dérmica es ambigua o historia de brote a 
algún medicamento. 
• ...
¿Y ENTONCES QUÉ 
ANTIBIÓTICO LE FORMULO AL 
PACIENTE?
ELECCIÓN DE SEGUNDA LINEA 
EN VERDADEROS ALÉRGICOS. 
• Cuando un paciente nos relate que es 
alérgico a la penicilina no n...
INFECCIONES DE CUELLO, 
MENINGES Y CEREBRO
FARINGITIS AGUDA
SINUSITIS
EXACERBACIÓN DE LA EPOC.
INFECCIONES PULMONARES
NEUMONIA ADQUIRIDA EN LA 
COMUNIDAD
NEUMONIA ADQUIRIDA EN LA 
COMUNIDAD
NEUMONIA ADQUIRIDA EN LA 
COMUNIDAD
ENDOCARDITIS
INFECCIONES INTRA-ABDOMINALES 
Y PÉLVICAS
ITU BAJA NO COMPLICADA
BACTERIURIA ASNTOMATICA Y 
CISTISIS EN EMBARAZO 
CISTITIS:
SEPSIS
Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.
Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.
Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.
Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.
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Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.

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Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.

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Alergia a las penicilinas: generalidades, reactividad cruzada, tratamiento y alternativas terapéuticas.

  1. 1. ALERGIA A LAS PENICILINAS Carolina Arango Sebastián Guerra Alejandro Montoya Valeria Rodríguez Sebastián Tamayo Estudiantes Medicina – CES.
  2. 2. • Alergias medicamentosas: reacciones adversas relacionadas a una particular respuesta inmunológica del organismo, dosis independientes, difíciles de predecir. La alergia a los B-lactámicos es la más frecuente alergia medicamentosa (30%): Hipersensibilidad inmediata Mediada por IgE Romano A, Warrington R. Antibiotic Allergy. Immunology and Allergy Clinics of North America. 2014;34(3):489-506.
  3. 3. Epidemiología • Penicilinas y cefalosporinas son los ATB más comunmente asociados con reacciones alérgicas. • Alergia a la penicilina es la más reportada, con una prevalencia de 5 – 10% en adultos y niños. Romano A, Warrington R. Antibiotic Allergy. Immunology and Allergy Clinics of North America. 2014;34(3):489-506.
  4. 4. • Desde hace 70 años. (introducción de la penicilina) • Sólo poco porcentaje de pacientes que reportan una reacción adversa por la penicilina tienen una verdadera reacción alérgica inmuno mediada. • EHR. (aumento de alergias no verificadas) • Aumento de estancia hospitalaria. • C.Difficile, ERV y SAMR. The Choosing Wisely (2014) Macy E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep. 2014;14(11).
  5. 5. • Uno de los ATB más usados en el mundo. • Reacciones alérgicas: 0.7% al 8%. • Anafilaxia: 0.004% - 0.015% de los casos. • Mortalidad: 0.0015% - 0.002% (Una muerte por cada 50.000 a 100.000 personas en tratamiento.) • 80 - 90% pruebas diagnosticas negativas. (evitan la penicilina innecesariamente) Macy E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep. 2014;14(11). Park MA, Li JT Diagnosis and management of penicillin allergy. Mayo Clin Proc 2005; 80: 405-10.
  6. 6. • 6.2% de los pacientes hospitalizados refieren AA de alergia a la penicilina, pero sólo 5 – 20% presenta reacciones alérgicas ante una nueva exposición. Costo asistencial adicional del 63% durante la hospitalización, y del 38% después. Macy E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep. 2014;14(11). Park MA, Li JT Diagnosis and management of penicillin allergy. Mayo Clin Proc 2005; 80: 405-10.
  7. 7. • 1% con AP + Pruebas cutáneas positivas presentará luego de recibir penicilina, reacciones urticarianas aceleradas, y un 3% tendrá otras manifestaciones leves. • No hay registro de anafilaxia en estos individuos. Macy E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep. 2014;14(11). Park MA, Li JT Diagnosis and management of penicillin allergy. Mayo Clin Proc 2005; 80: 405-10.
  8. 8. • 97% y el 99% de los pacientes con AP + Pruebas negativas, tolera los Beta lactámicos sin riesgo de reacción inmediata importante.
  9. 9. • En pacientes con pruebas cutáneas positivas, el riesgo de una reacción alérgica es del 10% cuando no hay AP, y del 50% al 70% cuando existen éstos. Macy E. Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. Curr Allergy Asthma Rep. 2014;14(11). Park MA, Li JT Diagnosis and management of penicillin allergy. Mayo Clin Proc 2005; 80: 405-10.
  10. 10. CLASIFICACION, ESTRUCTURA QUIMICA Y MECANISMOS DE ACCION
  11. 11. CLASIFICACION • PENICILINAS • AMINOPENICILINAS • CEFALOSPORINAS • CEFAMICINAS • CARBAPENEMS • MONOBACTAMICOS • INHIBIDORES DE BETALACTAMASA Romano A, Warrington R. Antibiotic Allergy. Immunology and Allergy Clinics of North America. 2014;34(3):489-506.
  12. 12. Romano A, Warrington R. Antibiotic Allergy. Immunology and Allergy Clinics of North America. 2014;34(3):489-506.
  13. 13. ESTRUCTURA
  14. 14. MECANISMO DE ACCION • Inhiben la enzima DD-Transpeptidasa • Activación del sistema endógeno auto lítico
  15. 15. Efectos Adversos de Beta lactámicos Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97 Penicilina BPO -Benzy-n-propilamina -Peniloato -Peniciloato
  16. 16. Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  17. 17. Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  18. 18. Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  19. 19. Gell y Coombs Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology.
  20. 20. Stevens-Johnson y Necrolisis Epidérmica Toxica Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  21. 21. Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  22. 22. Amoxicilina Chang C, MahmoodM, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  23. 23. Mecanismo Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1- 2):84-97
  24. 24. Clínica Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  25. 25. Factores de riesgo • Edad: 20 y 49 años. DHR son menos comunes en niños que en adultos. • Frecuencia y ruta de administración: Cursos repetidos de penicilina pueden favorecer el desarrollo de sensibilización alérgica.  Ruta de administración: Determina el tipo de respuesta inmune que se genera. Aplicación tópica. Vía parenteral (Reacciones tipo 1 y anafilaxia). Chiriac A, Demoly P. Drug Allergy Diagnosis. Immunology and Allergy Clinics of North America. 2014;34(3):461-471.
  26. 26. • Dosis: IV. • Síndrome de alergia a múltiples fármacos: reacciones alérgicas generadas por 2 o mas medicamentos. o Pacientes que generan reacción alérgica a un medicamento son mas propensos a desarrollar alergia a un 2do. Chiriac A, Demoly P. Drug Allergy Diagnosis. Immunology and Allergy Clinics of North America. 2014;34(3):461-471.
  27. 27. • Factores hereditarios: Evidencia limitada HLA-DRB (población china): alergia a la penicilina mediada por IgE. Niños con AF de primer grado de alergia a la penicilina tienen 15 veces más riesgo de ser alérgicos a los ATB. • Otras enf alérgicas: Asma. Chiriac A, Demoly P. Drug Allergy Diagnosis. Immunology and Allergy Clinics of North America. 2014;34(3):461-471.
  28. 28. • Exposiciones previas: 0,45% sin exposición previa y test cutáneo negativo, harán una reacción alérgica al recibir su primer inyección. Pacientes previamente expuestos, aún con tests cutáneos negativos y habiendo tenido tolerancia al fármaco administrado, tienen 10 veces más posibilidades de presentar una reacción alérgica ante una nueva exposición. La sensibilización a hongos Penicillum no es un factor de riesgo para desarrollar alergia a penicilinas. Guzmán M M. Antonieta, Salinas L Jessica, Toche P Paola, Afani S Alejandro. Alergia a beta-lactámicos. Rev. chil. infectol. [revista en la Internet]. 2004 Dic [citado 2014 Nov 14] ; 21( 4 ): 285-298.
  29. 29. PRUEBA CUTANEA PARA ALERGIA A PENICILINA SPT - IDT
  30. 30. • INMEDIATA (igE): urticaria, angioedema, anafilaxia, broncoespasmo. • ACELERADA (igE): urticaria. • TARDIA(complejos inmunes y LT): exantema maculo papular, dermatitis de contacto y toxicodermia.
  31. 31. INDICACIONES • FLUSH. • URTICARIA. • ANGIOEDEMA. • ANAFILAXIA. • CONJUNTIVITIS. • RINITIS. • ASMA O BRONCOESPASMO.
  32. 32. CONTRAINDICACIONES • ENFERMEDADES AUTOINMUNES • REACCIONES EXFOLIATIVAS
  33. 33. TIEMPO PARA REALIZAR EL TEST • 6 semanas a 6 meses
  34. 34. PRUEBA • IDT Y SPT (PPL o penicilina) – 1. Realizar dilución. – 2. hacer primero SPT. – 3. subir la concentración de la dilución exponencialmente. – 4. Realizar lectura de resultado.
  35. 35. FALSOS POSITIVOS - Paciente sensibilizado. - de granulación de mastocitos espontanea . - Alteración en la dilución. - Facticia. - Rxn alérgica al diluyente o preservativo . - Lectura inapropiada.
  36. 36. FALSOS NEGATIVOS – RAZONES TECNICAS: • Dilución inapropiada. • Penetración insuficiente. • Bloqueo del efecto por antihistamínicos. • Lectura inapropiada. RAZONES NO TECNICAS • Infecciones concomitantes. • Metabolismo tardío para la respuesta alérgica. • Presentación del antígeno al sistema inmune puede ser diferente si es vía oral, IM, IV o subcutánea. • Rxn previa y la degranulacion de mastocitos no se ha resuelto.
  37. 37. Manejo Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  38. 38. Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  39. 39. Chang C, Mahmood M, Teuber S, Gershwin M. Overview of Penicillin Allergy. Clinical Reviews in Allergy & Immunology. 2011;43(1-2):84-97
  40. 40. Reactividad cruzada con penicilina • Hasta un 25% de alérgicos a las cefalosporinas son alérgicos a la penicilina. • En un 10% hay sensibilidad cruzada entre penicilina y otros β lactámicos (cefalosporinas, carbapenems), considerándose la causa el anillo β lactámico. Chang C, MahmoodMM, Teuber SS, Gershwin ME. Overview of Penicillin Allergy. Clin Rev Allergy Immunol. 2012 Aug;43(1-2):84–97.
  41. 41. • Estudios recientes han mostrado que la sensibilidad cruzada con cefalosporinas de tercera generación es menor. Chang C, MahmoodMM, Teuber SS, Gershwin ME. Overview of Penicillin Allergy. Clin Rev Allergy Immunol. 2012 Aug;43(1-2):84–97.
  42. 42. Pichichero ME. Use of selected cephalosporins in penicillin-allergic patients: a paradigm shift. Diagn Microbiol Infect Dis. 2007 Mar;57(3):S13–S18.
  43. 43. • Cualquier reacción 4,3% • Reacciones: probadas, sospechadas o posibles mediadas por IgE: 2,4% • Relacion de test cutaneopositivo para penicilina y reaccion a carbapenems: 0,3%
  44. 44. Test de dosis • Se realiza si el resultado de la prueba dérmica es ambigua o historia de brote a algún medicamento. • Se administra de 3 a 6 dosis ascendentes hasta llegar a dosis plena. • Contraindicado si hay historia de reacciones no mediadas por IgE severas. Chang C, MahmoodMM, Teuber SS, Gershwin ME. Overview of Penicillin Allergy. Clin Rev Allergy Immunol. 2012 Aug;43(1-2):84–97.
  45. 45. ¿Y ENTONCES QUÉ ANTIBIÓTICO LE FORMULO AL PACIENTE?
  46. 46. ELECCIÓN DE SEGUNDA LINEA EN VERDADEROS ALÉRGICOS. • Cuando un paciente nos relate que es alérgico a la penicilina no nos conformemos con sólo consignar en la historia “alérgico a la penicilina” • SIEMPRE decir que tipo de reacción le produjo la penicilina y hacer las pruebas pertinentes para verificar el tipo de reacción. • Cuando este confirmada la alergia se procederá a elegir los antibióticos de 2da línea o a desensibilizar al paciente.
  47. 47. INFECCIONES DE CUELLO, MENINGES Y CEREBRO
  48. 48. FARINGITIS AGUDA
  49. 49. SINUSITIS
  50. 50. EXACERBACIÓN DE LA EPOC.
  51. 51. INFECCIONES PULMONARES
  52. 52. NEUMONIA ADQUIRIDA EN LA COMUNIDAD
  53. 53. NEUMONIA ADQUIRIDA EN LA COMUNIDAD
  54. 54. NEUMONIA ADQUIRIDA EN LA COMUNIDAD
  55. 55. ENDOCARDITIS
  56. 56. INFECCIONES INTRA-ABDOMINALES Y PÉLVICAS
  57. 57. ITU BAJA NO COMPLICADA
  58. 58. BACTERIURIA ASNTOMATICA Y CISTISIS EN EMBARAZO CISTITIS:
  59. 59. SEPSIS

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