Cefaclor and Serum Sickness-Like Reaction

Reynolds, Ronald D.

doi:10.1001/jama.1996.03540120028017

Cited by 11 publications

(6 citation statements)

References 4 publications

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“…The symptom complex and latent period of children affected with SSLR in this report correlate with that documented elsewhere in the literature 2−4,8 , 15,17 .…”

Section: Discussionsupporting

confidence: 86%

“…Uneventful rechallenge with other cephalosporins after cefaclor SSLR has been documented 4,27 . Reynolds reports anecdotal experience with 10 children with cefaclor SSLR in whom subsequent courses of beta lactams (type not specified) have been tolerated 17 . Prior to this current report there has been only a single report in the literature of either adverse event recurrence, or uneventful rechallenge with cefaclor.…”

Section: Discussionmentioning

confidence: 84%

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

King

Geelhoed

2003

J Paediatrics Child Health

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“…The symptom complex and latent period of children affected with SSLR in this report correlate with that documented elsewhere in the literature 2−4,8 , 15,17 .…”

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 84%

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

King

Geelhoed

2003

J Paediatrics Child Health

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“…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

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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...

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“…Resolution of symptoms occurs in weeks to months after a drug is stopped; however, the ANA can remain positive for 6-12 months (16). NSAIDs can be used for musculoskeletal pain (14). Sun protection should be enforced.…”

Section: Drug-induced Lupus Erythematosus (Dile)mentioning

confidence: 99%

“…A reactive cefaclor metabolite generated during its metabolism may bind with tissue proteins, resulting in a SSLR (13). For cefaclor, the risk of cross reaction with other beta‐lactam antibiotics is low, and other cephalosporins are usually tolerated (14).…”

Section: Serum Sickness‐like Reaction (Sslr)mentioning

confidence: 99%