Adverse skin and joint reactions associated with oral antibiotics in children: The role of cefaclor in serum sickness‐like reactions

King, Barbara; Geelhoed, Gary C.

doi:10.1046/j.1440-1754.2003.00267.x

Cited by 60 publications

(31 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cefaclor is an orally available second generation cephalosporin that enjoyed considerable popularity when introduced, in part due to excellent palatability compared to other liquid antibiotic preparations then available. However, when used in children between the ages of 1 and 6 years, cefaclor is associated with a 1% risk of developing a serum sickness‐like reaction characterized by erythema multiforme and centrifugal polyarthragia . There is a small body of work that suggests that differential sensitivity to reactive cefaclor metabolites between those children who can tolerate cefaclor and those who develop serum sickness‐like reactions may be the key first step in the pathogenesis of this serious ADR .…”

Section: The Ontogeny Of Adverse Drug Reactionsmentioning

confidence: 99%

“…However, when used in children between the ages of 1 and 6 years, cefaclor is associated with a 1% risk of developing a serum sickness-like reaction characterized by erythema multiforme and centrifugal polyarthragia. 48 There is a small body of work that suggests that differential sensitivity to reactive cefaclor metabolites between those children who can tolerate cefaclor and those who develop serum sickness-like reactions may be the key first step in the pathogenesis of this serious ADR. 49 Of relevance to ontogeny, the ADR rate of 1% for this ADR in children is at least 7-fold low higher than the rate for this problem in adults.…”

Section: S41mentioning

confidence: 99%

See 1 more Smart Citation

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Rieder

2018

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Adverse drug reactions (ADRs) are common and important complications of drug therapy for children. The risk for ADRs changes over childhood, as do the nature and types of ADRs. Importantly, the risk and nature of ADRs in children are markedly different from those of adults, and adult data cannot be relied on to guide safe drug therapy in children. There are groups of children, notably those with complex and chronic diseases, who are at substantial risk for ADRs. The evaluation of an undesired effect during therapy is ideally accomplished by an organized approach that is a skill that clinicians who care for children—especially those children at high risk for ADRs must have. Additionally, clinicians as well as drug regulatory agencies and industry need to be both vigilant and astute as well as aware that ADRs in children are often different in nature and frequency from those in adults. The increasing use of pharmacogenomics to guide drug dosing and the increasing number of biological agents will provide new sets of challenges to clinicians over the next decade.

show abstract

Section: The Ontogeny Of Adverse Drug Reactionsmentioning

confidence: 99%

Section: S41mentioning

confidence: 99%

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Rieder

2018

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Cefaclor is the most common culprit drug in development of SSLRs [74], other causes being minocycline and sulfonamides, and more recently biological agents like rituximab, infliximab, and natalizumab [75].…”

Section: Serum Sickness-like Reactionsmentioning

confidence: 99%

Eosinophilic Drug Allergy

Kuruvilla

Khan

2015

Clinic Rev Allerg Immunol

View full text Add to dashboard Cite

While peripheral or tissue eosinophilia may certainly characterize drug eruptions, this feature is hardly pathognomonic for a medication-induced etiology. While delayed drug hypersensitivity reactions with prominent eosinophilic recruitment have been typically classified as type IVb reactions, their pathophysiology is now known to be more complex. Eosinophilic drug reactions have a diversity of presentations and may be benign and self-limited to severe and life-threatening. The extent of clinical involvement is also heterogeneous, ranging from isolated peripheral eosinophilia or single organ involvement (most often the skin and lung) to systemic disease affecting multiple organs, classically exemplified by drug-reaction with eosinophilia and systemic symptoms (DRESS). The spectrum of implicated medications in the causation of DRESS is ever expanding, and multiple factors including drug metabolites, specific HLA alleles, herpes viruses, and immune system activation have been implicated in pathogenesis. Due to this complex interplay of various factors, diagnostic workup in terms of skin and laboratory testing has not been validated. Similarly, the lack of controlled trials limits treatment options. This review also describes other localized as well as systemic manifestations of eosinophilic disease induced by various medication classes, including their individual pathophysiology, diagnosis, and management. Given the multitude of clinical patterns associated with eosinophilic drug allergy, the diagnosis can be challenging. Considerable deficits in our knowledge of these presentations remain, but the potential for severe reactions should be borne in mind in order to facilitate diagnosis and institute appropriate management.

show abstract

“…However, this is incorrect because, although patients may have a recurrence on rechallenge with cefaclor, in vitro studies have shown a lack of cross-reactivity with similar molecules 12,13 and patients have been shown to tolerate other cephalosporins. [14][15][16] …”

Section: Exceptions Include Whenmentioning

confidence: 99%

Cephalosporin allergy label is misleading

Yuson¹,

Katelaris²,

Smith³

2018

Aust Prescr

View full text Add to dashboard Cite

SUMMARYPenicillins and cephalosporins can cause a similar spectrum of allergic reactions at a similar rate.Cross-reactive allergy between penicillins and cephalosporins is rare, as is cross-reaction within the cephalosporin group. Patients should therefore not be labelled 'cephalosporin-allergic'.Cross-reactive allergy may occur between cephalosporins (and penicillins) which share similar side chains.Generally, a history of a penicillin allergy should not rule out the use of cephalosporins, and a history of a specific cephalosporin allergy should not rule out the use of other cephalosporins.Specialist advice or further investigations may be required when the index reaction was anaphylaxis or a severe cutaneous adverse reaction, or when the antibiotics in question share common side chains.When recording a drug allergy in the patient's records, it is important to identify the specific drug suspected (or confirmed), along with the date and nature of the adverse reaction. Records need to be updated after a negative drug challenge. 'Cephalosporin allergy' label is misleadingas Stevens-Johnson syndrome, toxic epidermal necrolysis or acute generalised exanthematous pustulosis or organ hypersensitivity). Structural chemistry and allergyImmunological reactivity to small molecules such as antibiotics depends on the formation of haptens. These are stable covalent complexes of the drug with larger carrier molecules such as serum or membrane proteins. For penicillin, this occurs when the betalactam ring spontaneously opens to form penicilloyl which binds to lysine residues on host proteins. Beta-lactam ringCephalosporins and penicillins share the four-atom beta-lactam ring structure. In penicillins the betalactam ring is linked to a five-member thiazolidine ring whereas in cephalosporins it is linked to the dihydrothiazine ring (see Figs 1 and 2).It was previously thought that people allergic to penicillins had a high likelihood of allergy to any cephalosporins (reportedly up to 23.9%).7 More recent studies have demonstrated cross-reactivity rates as low as 1%. 8The common beta-lactam ring is the putative reason for potential cross-reactivity between penicillins and cephalosporins. However, there is in fact little theoretical basis for this. Penicillins are chemically reactive due to a high degree of tension between the beta-lactam ring and the thiazolidine ring, whereas the cephalosporin beta-lactam ring forms a more IntroductionTo label an individual with a 'cephalosporin allergy' is misleading. Given the structural diversity of the cephalosporin family, hypersensitivity is seldom a class effect but is much more likely to relate to the individual drug. Cross-reactivity within the family is very limited and is more likely to relate to the side chain than the core structure.1 A greater awareness of this in clinical practice would lead to the availability of alternative cephalosporins and prevent unnecessary use of other classes of broad-spectrum antibiotics.Cephalosporins were first introduced in the 1960s, 2 and are one of...

show abstract

Adverse skin and joint reactions associated with oral antibiotics in children: The role of cefaclor in serum sickness‐like reactions

Abstract: Cefaclor was associated with 53.3% of oral antibiotic related skin and joint adverse reactions and 84.1% of SSLR. The indications for its use in paediatric illness require careful reconsideration. ADRAC data under-represents the incidence of cefaclor SSLR.

Cited by 60 publications

References 28 publications

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Adverse Drug Reactions Across the Age Continuum: Epidemiology, Diagnostic Challenges, Prevention, and Treatments

Eosinophilic Drug Allergy

Cephalosporin allergy label is misleading

Contact Info

Product

Resources

About