![]() Medications are the most common cause of SCAR’s causing >85% of cases of SCAR’s in adults, of which beta-lactams are frequently implicated ( 2, 3). Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is another delayed cutaneous exanthema which can be severe. Severe cutaneous adverse reactions (SCAR’s) are a heterogeneous group of delayed T cell mediated hypersensitivity reactions, which include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) ( 1). Based on our experience we provide clinicians with a practical algorithm for testing for cross-reactivity in non-SJS/TEN severe cutaneous adverse reactions. In our case series cross-reactivity or co-reactivity commonly occurred among the beta-lactam antibiotic class, however further research is required to investigate and understand patterns of cross-reactivity. We assessed patients presenting with non-SJS/TEN severe cutaneous adverse reactions to a tertiary hospital drug allergy clinic. Historically, these reactions were considered to be specific to the inciting antibiotic and therefore likely to have minimal cross-reactivity. The underlying immunopathogenesis of these reactions is not completely understood but involves interactions between small molecule drugs, T cells and HLA molecules. 2Medical School, University of Western Australia, Nedlands, WA, AustraliaĬurrent understanding of cross-reactivity in severe cutaneous adverse reactions to beta-lactam antibiotics is limited, thereby making recommendations for future prescribing difficult.1Queen Elizabeth II Medical Centre, Department of Clinical Immunology, Sir Charles Gairdner Hospital, Pathwest, Nedlands, WA, Australia.Grace Thompson 1 Andrew McLean-Tooke 1 Michaela Lucas 1,2*
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