Patients with Allergies to One Cephalosporin Often Can Tolerate Others.

[Argirios Argiriou]

September 29, 2015

Patients with Allergies to One Cephalosporin Often Can Tolerate Others

David J. Amrol, MD reviewing Romano A et al. J Allergy Clin Immunol 2015 Sep.

Cephalosporin hypersensitivity does not seem to be a class hypersensitivity.

Cephalosporins can cause IgE-mediated allergic reactions, which are characterized by urticaria, angioedema, bronchospasm, and anaphylactic shock, typically within 1 hour. Studies suggest that allergy to cephalosporins is mediated by their molecular side chains, but we know little about cross-reactivity among different cephalosporins.

Researchers at two Italian allergy clinics evaluated 102 patients with histories of cephalosporin allergies. All patients underwent oral challenges and skin testing to penicillin, ampicillin, amoxicillin, and 11 cephalosporins. Cross-reactivity occurred within a group of cephalosporins that have a common side chain (cefuroxime, ceftriaxone, cefotaxime, cefepime, and ceftazidime) and within a group consisting of ampicillin and two aminocephalosporins (cefaclor and cephalexin). Patients who were allergic to cephalosporins in one group generally tolerated drugs from the other group. Cefazolin typically was tolerated by patients with allergies to cephalosporins in either group.

COMMENT

IgE-mediated penicillin allergy typically is caused by penicillin metabolites that contain the β-lactam ring, whereas cephalosporin allergy is caused mainly by side chains. Thus, patients with penicillin allergies usually can tolerate all cephalosporins, and patients with cephalosporin allergies usually can tolerate a cephalosporin with a different side chain. Rarely, a patient with a history of penicillin or cephalosporin allergy might react to another cephalosporin because of its β-lactam ring or other unexplained metabolites, so performing skin testing or a graded challenge is recommended prior to administering a cephalosporin to such a patient.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for David J. Amrol, MD at time of publication

EquityAbbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health

Leadership positions in professional societiesAllergy Society of South Carolina (Past President)

CITATION(S):

Romano A et al. IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins. J Allergy Clin Immunol 2015 Sep; 136:685. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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