Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report

Lee, Myeong Jong; Lim, Tae Ha; Lee, Bong Jae; Yi, Jae Woo; Park, Suk Hee; Choi, Su Kyeong

doi:10.4097/kjae.2005.49.6.861

Cited by 4 publications

(3 citation statements)

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“…Most immediate reactions to cephalosporins are IgE mediated, which has been supported by positive results with skin tests and detection of serum-specific IgE antibodies. 6 , 7 Previously, Lee et al 5 reported a case of cefotetan-induced anaphylaxis; this case was only confirmed by SPT. Skin tests have been the most generalized approach for diagnosing immediate hypersensitivity to beta-lactams; however, the sensitivity of the tests is not optimal.…”

Section: Discussionmentioning

confidence: 95%

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Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

Nam

Hwang

Ban

et al. 2015

Allergy Asthma Immunol Res

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Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.

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Section: Discussionmentioning

confidence: 95%

“…Cefotetan-induced anaphylaxis has rarely been reported. 4 , 5 The incidence of cefotetan-induced anaphylactic reaction was 1.4% for surgical prophylaxis in cesarean sections and hysterectomies at a single hospital. 4 All of the reactions developed immediately and were life threatening, consistent with those in our 2 cases.…”

Section: Discussionmentioning

confidence: 99%

Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

Nam

Hwang

Ban

et al. 2015

Allergy Asthma Immunol Res

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“…Cefotetan-induced anaphylaxis has rarely been observed. [ 5 , 6 ] The incidence of cefotetan-induced anaphylactic reaction was 1.4% for surgical prophylaxis in cesarean sections. [ 5 ] Our patient was exposed previously to cefotetan antibiotics several times without any allergic reactions, suggesting that the immunologic changes in pregnancy may have triggered a new onset of sensitization.…”

Section: Discussionmentioning

confidence: 99%

Maternal anaphylactic shock in pregnancy

Jeon

Ryu²,

Min³

et al. 2018

Medicine

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Rationale:Anaphylaxis is a very rare event in pregnancy, triggering maternal hypotension leading to intrapartum hypoxic-ischemic encephalopathy in infant. Furthermore, cesarean sections are performed at a high rate in anaphylactic pregnant women.Patient concerns:A 34-year-old pregnant woman presented with maternal anaphylaxis following prophylactic antibiotic injection for cesarean section. Within a few minutes after initiation of intradermal skin test with cefotetan, the pregnant woman developed generalized itchy rash, chest tightness, and dyspnea.Diagnoses:Several minutes after the injection of antibiotics, a diffuse urticarial rash was detected over her face and trunk followed by complaints of chest tightness and dyspnea. She was diagnosed with hypotension and hypoxia. Further, fetal heart tones showed bradycardia. A presumptive diagnosis of anaphylactic reaction induced by cefotetan was made for surgical prophylaxis.Interventions:The patient was managed for anaphylaxis, via administration of epinephrine, glucocorticoid, and antihistamine. Emergency cesarean section performed under general anesthesia resulted in a favorable perinatal outcome for the fetus.Outcomes:Maternal and fetal outcomes were good after prompt treatment for anaphylaxis and emergency cesarean section.Lessons:This is the first reported case of anaphylaxis following cefotetan administration in pregnancy. Cefotetan, a second-generation cephalosporin, is a commonly prescribed antibiotic used to treat a wide range of bacterial infections. The case demonstrated life-threatening anaphylactic reaction during pregnancy. Even a skin test using antibiotics alone triggered anaphylaxis.

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IgE-Mediated Hypersensitivity Reactions to Cephalosporins

Kim

Cho

2010

Infect Chemother

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Cephalosporins are commonly prescribed either orally or parenterally for the treatment of bacterial infections because of wide safety margin compared with penicillins. Skin testing with a parent cephalosporin antibiotic has routinely been performed in Korea in the fear of developing anaphylaxis after the administration of a cephalosporin although penicillins are antibiotics that most commonly induce severe or life-threatening IgE-mediated reactions (anaphylaxis). In this review, we will discuss IgE-mediated hypersensitivity reactions to cephalosporins. Immunopathogenesis of IgE-mediated hypersensitivity reaction to cephalosporins, limitations of skin testing with parent cephalosporin antibiotics, and prescription strategy of cephalosporins for patients with a history of cephalosporin or penicillin hypersensitivity was described.

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Anaphylactic Reaction to Cefotetan during Spinal Anesthesia: A case report

Cited by 4 publications

References 0 publications

Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

Immunologic Evaluation of Patients with Cefotetan-Induced Anaphylaxis

Maternal anaphylactic shock in pregnancy

IgE-Mediated Hypersensitivity Reactions to Cephalosporins

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