Cephalosporin Allergy: Current Understanding and Future Challenges

Khan, David A.; Banerji, Aleena; Bernstein, Jonathan A.; Bilgiçer, Başar; Blumenthal, Kimberly G.; Castells, Mariana; Ein, Daniel; Lang, David M.; Phillips, Elizabeth

doi:10.1016/j.jaip.2019.06.001

Cited by 92 publications

(59 citation statements)

References 86 publications

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“…11 In particular, cephalosporins are one of the leading causes for perioperative anaphylaxis and SCARs. 59 Even though STs with cephalosporins are not as well validated as those with penicillins, 7,42,59 studies carried out on at least 20 subjects demonstrated that they are reliable and effective for diagnosing both immediate [60][61][62][63][64][65] and delayed hypersensitivity 66 to these β-lactams. Of note, in a Korean study, 67 74 (5.2%) of 1421 participants who underwent preoperative cephalosporin STs were positive to at least one cephalosporin.…”

Section: Cephalosporin-allergic Subjectsmentioning

confidence: 99%

β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

Valluzzi¹,

Colantuono²,

Gaeta³

et al. 2021

JAA

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β-Lactams which include penicillins, cephalosporins, carbapenems, and monobactams are the most common antibiotic classes reported to cause allergic reactions to drugs. This review is mainly about published studies assessing the cross-reactivity among β-lactams in penicillin-or cephalosporin-allergic subjects by carrying out diagnostic tests with alternative β-lactams and, if appropriate, graded challenges. Several studies demonstrated that cross-reactivity connected with the β-lactam ring, causing positive responses to allergy tests with all β-lactams, is infrequent in subjects with an IgE-mediated allergy and anecdotal in those with a T-cell-mediated allergy. Identities or similarities of βlactam side-chain structures are mainly responsible for cross-reactivity among these antibiotics. For example, in aminopenicillin-allergic subjects, cross-reactivity with aminocephalosporins could possibly be over 30%. On the other hand, in a few prospective studies of penicillin-allergic individuals, less than 1% of cases show a cross-reactivity between penicillins and both aztreonam and carbapenems. Particular patterns of allergytest positivity observed in some studies that assessed cross-reactivity among β-lactams seem to indicate that prior exposures may be responsible for coexisting sensitivities. Therefore, pre-treatment skin tests with the related β-lactams are suggested before administering them via graded challenges to β-lactam-allergic patients who need alternative β-lactams.

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Section: Cephalosporin-allergic Subjectsmentioning

confidence: 99%

β-Lactam Allergy and Cross-Reactivity: A Clinician’s Guide to Selecting an Alternative Antibiotic

Valluzzi¹,

Colantuono²,

Gaeta³

et al. 2021

JAA

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“…9 Finally, a recent review of drug allergy provides a modified Gell-Coombs reaction which is most applicable for drug sensitivity. 13 Its specifics will be discussed under drug allergy.…”

Section: Hypersensitivity Terminology: Historical and Currentmentioning

confidence: 99%

“…A recent review of cephalosporin allergy presented a modified Gell and Coombs hypersensitivity schematic that is pertinent to drug allergy, and is thus presented in this study. 13 This classification was drawn from previous reviews, 51,52 but schematized by Khan. 13 It has applicability for antibiotic and nonantibiotic drugs, and overlaps conceptually with another publication of drug allergy (Table 14).…”

Section: Antibiotic/drug Allergymentioning

confidence: 99%

Hypersensitivity Reactions: An Everyday Occurrence in Pediatric Allergy Clinics

Hopp

2020

Pediatric Allergy, Immunology, and Pulmonology

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The explanation of hypersensitivity reactions has long relied on the classification of Gell and Coombs, originally proposed in the 1960s. However, their concepts were predated by other authors by at least 50 years. A 21st century pediatric allergy clinic provides multiple examples of these basic concepts on a daily basis. We review classic and less classic examples of the original criteria, highlight where current disease pathophysiology does not always fit the original model, and provide updated language for common and uncommon immunologically driven hypersensitivity diseases.

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“…Cephalosporins are the most commonly used β-lactam antibiotics for treatment of various infections and prevention of infections in patients undergoing surgery 1. Immediate hypersensitivity to penicillin is well known, and its diagnostic skin test has been extensively validated for predicting and diagnosing immediate hypersensitivity to penicillin, such as anaphylaxis; however, the cephalosporin skin test has not been well validated.…”

mentioning

confidence: 99%

“…Currently, cephalosporins have been widely and safely used in individuals with a history of penicillin allergy, despite concerns regarding immune cross-reactivity with both drugs. Even individuals allergic to cephalosporin can tolerate other cephalosporins with different R1 side chain because immunoglobulin E-mediated allergic reactions to β-lactams are mainly attributed to R1 side chains and not to the β-lactam ring itself 1…”

mentioning

confidence: 99%