A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross‐reactivities

Pipet, A.; Veyrac, G.; Wessel, F.; Jolliet, Pascale; Magnan, A.; Demoly, Pascal; Bousquet, Philippe‐Jean

doi:10.1111/j.1365-2222.2011.03846.x

Cited by 42 publications

(31 citation statements)

References 19 publications

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“…Previous cross-reactivity studies [12][13][14][15][16][17] demonstrated that cefazolin hypersensitivity is mainly a selective hypersensitivity, that is, it does not involve cross-reactivity with other cephalosporins and/or penicillins. In effect, in these studies, the great majority, namely 20 of 22, of patients suffering from an IgE-mediated hypersensitivity to cefazolin displayed a pattern of selective response to it.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] The fact that cephalosporin hypersensitivity is not a class hypersensitivity has recently been reported in a series of patients by Romano et al 12 Regarding cefazolin, studies conducted up to now showed that IgE-mediated hypersensitivity toward cefazolin appears to be selective in the great majority of allergic subjects. [12][13][14][15][16][17] As a first objective of this study, we sought to confirm whether a test concentration higher than 2 mg/mL could increase the sensitivity of the skin tests, and add to the diagnosis in patients who would otherwise yield negative skin test responses. The second part of our study aimed at investigating the crossreactivity between cefazolin and other b-lactam antibiotics.…”

Section: Abbreviations Used Bp-benzylpenicillin Cd-cumulative Dose Enmentioning

confidence: 99%

See 1 more Smart Citation

Cefazolin Hypersensitivity: Toward Optimized Diagnosis

Uyttebroek

Decuyper

Bridts

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Discussionmentioning

confidence: 99%

Section: Abbreviations Used Bp-benzylpenicillin Cd-cumulative Dose Enmentioning

confidence: 99%

Cefazolin Hypersensitivity: Toward Optimized Diagnosis

Uyttebroek

Decuyper

Bridts

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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“…This may be explained by its chemical structure, with a different R1 side-chain from other beta-lactams [6]. The R1 side-chain of cefazolin consists of a heterocycle N-methylthiodiazole structure, which is different from other cephalosporin R1 side-chains [6, 13, 17]. There is no other cephalosporin commercially available in Portugal with this side chain.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

Mota

Gáspár

Morais‐Almeida³

2018

Int Arch Allergy Immunol

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Background: Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions. Methods: Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests. Results: We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE-mediated hypersensitivity through positive skin tests to cefazoline has been proven in all patients. Two patients experienced systemic reactions during skin testing. All patients were successfully challenged with amoxicillin, and they tolerated cefuroxime. Conclusions: Cefazolin can be responsible for immediate severe allergic reactions in perioperative setting, including KS. Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. Our experience confirmed that patients with IgE-mediated hypersensitivity reactions to cefazolin can tolerate other beta-lactams. This selective pattern of clinical reactivity may be explained by its particular chemical structure, whose R1 side-chain is different from other beta-lactams.

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“…The percentage of patients with IgE-mediated allergic reactions to cephalosporins that tolerate penicillin ranges from 50 to 90 %, differences that may be related to the culprit cephalosporin [48][49][50][51]. Tolerance to penicillin is lower with first-generation cephalosporins, probably due to the similarity in the R 1 side chain chemical structure.…”

Section: Penicillin As An Alternative Treatmentmentioning

confidence: 99%

“…However, others factors must be involved, since more than 50 % of cross-reactive cases responded to penicillins and cephalosporins with different side chain structures [52]. In another study including ten patients with confirmed IgE-mediated allergy to cefazolin, cross-reactivity with penicillin was only detected in 10 % of cases [51]. In children, similar figures of cross-reactivity have been found, ranging from 0.3 to 23.9 %, with the figure being higher for earlier generation cephalosporins [53].…”

Section: Penicillin As An Alternative Treatmentmentioning

confidence: 99%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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Opinion statementIt was originally thought that, as all betalactams share a four-member ring, they would cross-react, and so the classical recommendation was for allergic patients to avoid all betalactams. However, later studies found that some individuals selectively responded to one betalactam only and tolerated others. This was shown to be more frequent than initially thought, and this finding has led to a change from the initial recommendations of complete avoidance. Selective responses to amoxicillin are mainly due to recognition of the side chain structure, making benzylpenicillin a safe alternative. These amoxicillin-selective responders comprise up to 55 and 90 % of patients with immediate allergic reactions to amoxicillin and amoxicillin-clavulanic, respectively. Additionally, more than 85 % of penicillin-allergic patients can tolerate cephalosporins with different R 1 side chains, decreasing to 65 % if the side chain is identical. It is known that third and fourth generation cephalosporins are well tolerated by penicillin-allergic patients, probably because their chemical structures differ more from penicillins that those from the first generation. In patients with IgE-mediated allergic reactions to cephalosporins, penicillins can be an alternative treatment in up to 75 % of cases. Moreover, 40 % of patients primarily sensitized to a given cephalosporin also react to others, which might be because some cephaloporins have the same (ceftriaxone and cefotaxime) or very similar (ceftriaxone and cefuroxime) side chain structures. Finally, carbapenems and monobactams are good alternative for patients with penicillin and/or cephalosporin allergy because cross-reactivity occurs in G1 % of these cases. For all betalactams, tolerance is higher in T-cell-mediated reactions than IgE-mediated. These results show that alternative treatments for infectious disease are available to patients with allergic reactions to betalactams, from within the same group of antibiotics. Nevertheless, this general rules need to be analyzed patient by patient, and skin tests and graded challenge with the betalactam that is going to be administered are recommended. Keypoints• Patients with IgE-or T-cell-mediated allergy to betalactams can have selective reactions, specific to one betalactam with good tolerance to others, or be crossreactive, recognizing several different chemically related betalactams.• The percentage of selective reactions to the different betalactam compounds is higher than previously reported and patients should be studied in order to increase the treatment options available.

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A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross‐reactivities

Cited by 42 publications

References 19 publications

Cefazolin Hypersensitivity: Toward Optimized Diagnosis

Cefazolin Hypersensitivity: Toward Optimized Diagnosis

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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