Cephalosporin Hypersensitivity: Descriptive Analysis, Cross-Reactivity, and Risk Factors

Touati, Nidhal; Cardoso, Bárbara Kong; Delpuech, Marie; Bazire, Raphaëlle; Kara, Nathalie El; Ouali, Djamila; Demoly, Pascal; Chiriac, Anca‐Mirela

doi:10.1016/j.jaip.2020.11.063

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…According to our data, patients who report a history of allergy to cephalosporins are more likely to be allergic than patients who report an allergy to penicillins (overall 18.9% vs. 16.4% of patients). Furthermore, we confirm that a delayed-type allergy to cephalosporins is a rare condition, as already shown by others ( 13 , 18 ).…”

Section: Discussionsupporting

confidence: 91%

“…For immediate- and delayed-type reactions to cephalosporins, we determined a NPV of skin tests of 100 and 87.5%, respectively. These results are based on 17 patients for immediate-type, and 8 patients for delayed-type reactions, which likely overestimate these values compared to recent larger studies ( 18 ).…”

Section: Discussioncontrasting

confidence: 56%

“…The limitations of this research include the low number of patients in some subgroups. Accordingly, results of NPV for cephalosporins are based on only 17 patients for immediate-type reactions, and 8 patients for delayed-type reactions, which likely overestimate these values compared to recent larger studies ( 18 ).…”

Section: Discussionmentioning

confidence: 83%

“…The data available on the epidemiology of cephalosporins allergy are more limited than those on penicillins allergy ( 13 – 17 ). A recent large French retrospective study found that allergy to cephalosporins was proven in 22.3% of the patients and the majority of these reactions were immediate-type ( 18 ). According to our data, patients who report a history of allergy to cephalosporins are more likely to be allergic than patients who report an allergy to penicillins (overall 18.9% vs. 16.4% of patients).…”

Section: Discussionmentioning

confidence: 99%

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Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study

et al. 2022

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Beta-lactam allergy is a common problem in everyday medical practice and is recognized as a major public health issue. Carrying this label frequently leads to the avoidance of all beta-lactam antibiotics, favoring the use of other less preferred classes of antibiotics, that are more expensive and associated with more side effects and increased antimicrobial resistance. Therefore, delabeling a beta-lactam allergy is part of antimicrobial stewardship programs. Herein, we retrospectively examined the clinical records of 576 patients who were referred to our center for a label of allergy to beta-lactam antibiotics and were systematically investigated following a standardized algorithm. Our main aim was to evaluate the frequency of confirmed immediate- and delayed-type allergy to commonly prescribed subclasses of beta-lactam antibiotics (penicillin and cephalosporin), as well as the negative predictive value (NPV) and the sensitivity of skin tests. Our secondary aims were to examine the safety of beta-lactam skin testing and drug challenge. We identified that 260 patients reported a history of immediate reactions, 131 of delayed reactions, and 114 of unknown timing or mechanism of reactions. Following assessment and testing, 86 (18.3%) patients had a confirmed allergy to any beta-lactam antibiotics; 63 (13.4%) with an immediate- and 23 (4.9%) with a delayed-type reaction. Most frequently identified confirmed allergy was to penicillins (65 patients), followed by cephalosporins (21 patients). When immediate-type reactions were examined, NPV of skin tests were 96.3% and 100% for penicillins and cephalosporins, respectively. When delayed reactions were considered, NPV were 91.9 and 87.5% for penicillins and cephalosporins, respectively. Evaluation of the safety of skin tests according to the standardized procedure showed that systemic allergic reactions occurred in only 0.7% of skin tests and in 3.1% of drug challenges. Overall, our data indicate that only 18.3% of patients with a beta-lactam allergy label have a confirmed allergy and non-allergic patients can be safely delabeled through allergic workup based on skin tests and drug challenge. This approach supports the policy of saving second-line antibiotics through a standardized allergy workup.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Management of Beta-Lactam Antibiotics Allergy: A Real-Life Study

et al. 2022

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“…In the majority of clinical settings where graded drug challenges are not available, the possibility of false negative as well as false positive tests must be considered. Skin testing for neuromuscular blocking agents is in general considered sensitive with a high negative predictive value 17–19 whereas skin testing for antibiotics such as cephalosporins may be less sensitive, 20 so could potentially result in false negative skin tests when a drug provocation test would be positive. At the conclusion of a testing protocol, a careful interpretation of test findings and re‐evaluation of all possible drugs and exposures as well as underlying disease is therefore necessary in all patients with suspected POH.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of a medical algorithm for investigation of perioperative hypersensitivity reactions

Sverrild

Carruthers

Murthee

et al. 2022

Allergy

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Perioperative hypersensitivity (POH) following administration of anaesthetics or other agents during anaesthesia for surgical procedures is generally rare but can be severe and life-threatening. 1,2 Immunoglobulin E (IgE)-mediated reactions account for 50-70% of POH and confer a greater risk of severe reactions upon re-exposure. 3,4 Every effort should be made to identify and avoid the culprit agent in order to prevent future episodes.It is important to correctly diagnose patients likely to have experienced an IgE-mediated POH, so that they can proceed to appropriate testing for potential culprit agents. However, clinical evaluation of POH can be complex and challenging due to the simultaneous administration of multiple suspect agents exerting a variety of

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