Clinical cross-reactivity between amoxicillin and cephadroxil in patients allergic to amoxicillin and with good tolerance of penicillin

Sastre, Joaquı́n; Quijano, Leovigildo; Novalbos, A; Hernández, Guadalupe Margarita González; Cuesta, J; Heras, M. De las; Lluch, M; Fernández, Maribel

doi:10.1111/j.1398-9995.1996.tb00146.x

Cited by 77 publications

(32 citation statements)

References 11 publications

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“…Therefore, cefadroxil, cefradine, cefaclor and cefalexin have significant cross-reactivity in patients with a previous history of allergic reaction to ampicillin/amoxicillin because of similarities in side chain structure (table 3a,b) [89]. Amoxicillin and cefadroxil have a reported cross-reactivity as high as 38% [201,202]. In a prospective study [127] of 128 patients allergic to penicillin, 10.9% (14/ 128) were skin test positive for at least one cephalosporin; of these, 64% (9/14) reacted with a cephalosporin displaying the same side chain as the penicillin (cefamandole, cephalothin), but 36% (5/14) were sensitized to a cephalosporin with a different side chain.…”

Section: Cross-reactivity Between Cephalosporins and Penicillinsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Cross-reactivity Between Cephalosporins and Penicillinsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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“…In vitro studies confirmed that these patients had IgE antibodies that preferentially recognized the AX side chain structure [29]. These initial studies changed the paradigm that patients with hypersensitivity reactions to any particular penicillin should avoid penicillins altogether.…”

Section: Penicillin As An Alternative Treatmentmentioning

confidence: 58%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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Opinion statementIt was originally thought that, as all betalactams share a four-member ring, they would cross-react, and so the classical recommendation was for allergic patients to avoid all betalactams. However, later studies found that some individuals selectively responded to one betalactam only and tolerated others. This was shown to be more frequent than initially thought, and this finding has led to a change from the initial recommendations of complete avoidance. Selective responses to amoxicillin are mainly due to recognition of the side chain structure, making benzylpenicillin a safe alternative. These amoxicillin-selective responders comprise up to 55 and 90 % of patients with immediate allergic reactions to amoxicillin and amoxicillin-clavulanic, respectively. Additionally, more than 85 % of penicillin-allergic patients can tolerate cephalosporins with different R 1 side chains, decreasing to 65 % if the side chain is identical. It is known that third and fourth generation cephalosporins are well tolerated by penicillin-allergic patients, probably because their chemical structures differ more from penicillins that those from the first generation. In patients with IgE-mediated allergic reactions to cephalosporins, penicillins can be an alternative treatment in up to 75 % of cases. Moreover, 40 % of patients primarily sensitized to a given cephalosporin also react to others, which might be because some cephaloporins have the same (ceftriaxone and cefotaxime) or very similar (ceftriaxone and cefuroxime) side chain structures. Finally, carbapenems and monobactams are good alternative for patients with penicillin and/or cephalosporin allergy because cross-reactivity occurs in G1 % of these cases. For all betalactams, tolerance is higher in T-cell-mediated reactions than IgE-mediated. These results show that alternative treatments for infectious disease are available to patients with allergic reactions to betalactams, from within the same group of antibiotics. Nevertheless, this general rules need to be analyzed patient by patient, and skin tests and graded challenge with the betalactam that is going to be administered are recommended. Keypoints• Patients with IgE-or T-cell-mediated allergy to betalactams can have selective reactions, specific to one betalactam with good tolerance to others, or be crossreactive, recognizing several different chemically related betalactams.• The percentage of selective reactions to the different betalactam compounds is higher than previously reported and patients should be studied in order to increase the treatment options available.

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“…23 Notwithstanding, other authors do not accord with the side-chain hypothesis. 24 Fine structure within the side-chain such as methylene group has also been suggested as an antigenic determinant common to penicillins and cephalosporins. 25 …”

Section: Mechanism Of Cross-reactivity and The Side-chain Hypothesismentioning

confidence: 99%

“…Two (12%) were found to be cross-reactors. 24 Novalbos et al 46 recruited 41 patients with a history of penicillin hypersensitivity confirmed by either skin test or drug challenge. Patients were then challenged with three cephalosporins (cephazoline, cefuroxime and ceftriaxone) with side-chains which were different from that of penicillin.…”

Section: Clinical Reaction To Cephalosporins In Patients With Penicilmentioning

confidence: 99%

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

Qu¹

2014

Hong Kong Med J

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A 10% cross-reactivity rate is commonly cited between penicillins and cephalosporins. However, this figure originated from studies in the 1960s and 1970s which included first-generation cephalosporins with similar side-chains to penicillins. Cephalosporins were frequently contaminated by trace amount of penicillins at that time. The sidechain hypothesis for beta-lactam hypersensitivity is supported by abundant scientific evidence. Newer generations of cephalosporins possess side-chains that are dissimilar to those of penicillins, leading to low cross-reactivity. In the assessment of crossreactivity between penicillins and cephalosporins, one has to take into account the background betalactam hypersensitivity, which occurs in up to 10% of patients. Cross-reactivity based on skin testing or in-vitro test occurs in up to 50% and 69% of cases, respectively. Clinical reactivity and drug challenge test suggest an average cross-reactivity rate of only 4.3%. For third-and fourth-generation cephalosporins, the rate is probably less than 1%. Recent international guidelines are in keeping withUse of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited The ten per cent myth about betalactam cross-reactivityPenicillins and cephalosporins are two groups of widely prescribed antibiotics. They belong to the class of beta-lactam (BL) antibiotics because both possess the same BL nucleus. Allergic reactions are common side-effects of BL antibiotics. Studies in the 1960s and 1970s frequently estimated 10% crossreactivity between penicillins and cephalosporins. 1,2 However, at least two recent reviews showed much lower cross-reactivity. 3,4 Notably, cross-reactivity is higher between penicillins and first-and secondgeneration cephalosporins compared with thirdand fourth-generation cephalosporins. 5 The latter two groups are considered safe alternatives for patients with penicillin hypersensitivity. 6 The 10% cross-reactivity rate has recently been questioned as a medical myth. 4,7 Yet until 2005, an influential drug reference such as the British National Formulary (BNF) abided by the "10% rule". 8 Faced with such recommendation, an ordinary physician naturally avoids all BL antibiotics in patients with a history

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Clinical cross-reactivity between amoxicillin and cephadroxil in patients allergic to amoxicillin and with good tolerance of penicillin

Cited by 77 publications

References 11 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

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