Cross-reactivity between a penicillin and a cephalosporin with the same side chain☆, ☆☆, ★, ★★

Miranda, A.; Blanca, Miguel; Vega, José M.; Moreno, F.; Carmona, Marı́a José; Garcı́a, J.J.; Segurado, E; Justicia, José L; Juárez, C.

doi:10.1016/s0091-6749(96)70101-x

Cited by 145 publications

(104 citation statements)

References 21 publications

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“…On the other hand, use of cefamandole, a second-generation cephalosporin with a different side-chain from amoxicillin and cephadroxil, did not result in any cross-reactivity. 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.…”

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

confidence: 95%

“…Similarly, the same 2-amino-2-(4-hydroxyphenyl) acetic acid side-chain is present in amoxicillin and cefadroxil but not in new generations of cephalosporins. 16 In another study on selective amoxicillin hypersensitivity, Miranda et al 23 have shown that oral challenge with cephadroxil, a firstgeneration cephalosporin that shared the same sidechain mentioned above, resulted in a cross-reactivity of 38%. On the other hand, use of cefamandole, a second-generation cephalosporin with a different side-chain from amoxicillin and cephadroxil, did not result in any cross-reactivity.…”

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

confidence: 99%

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

confidence: 95%

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

confidence: 99%

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

Qu¹

2014

Hong Kong Med J

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“…Cephalosporins undergo fragmentation of the BL and dihydrothiazine rings, and the resultant compounds are extremely unstable with cephalosporoyl adducts degrading through dihydrothiazine ring rupture, with the expulsion of R 2 the substituent, leading to multiple structures that have not been well defined [8,9]. This unresolved question, as well as whether R 1 and/or R 2 side chains are part of the antigenic determinant, may have important implications for the allergic response.…”

Section: Bl Antigenic Determinantsmentioning

confidence: 99%

“…However, selective and cross-reacting are clinical concepts, and although in vitro tests can help, they are not always able to predict the response, in most cases overestimating cross-reactivity [5]. In fact, some degree of IgE recognition to BP has been found in immunoassays and basophil activation test (BAT) in patients with selective reaction to AX and good clinical tolerance to BP [5,9,15,16]. As with IgE-mediated reactions, T-cell-mediated responses to aminopenicillins involve recognition of both the core structure of the BL and the whole molecule (core structure plus side chain) by T cells [17].…”

Section: Bl Immunological Recognitionmentioning

confidence: 99%

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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“…Esse fato ocorre mais comumente com as cefalosporinas de primeira geração 11,12,32 . Romano et al 13 descreveram 30 pacientes com reações imediatas (25 com choque anafilático) a uma das cefalosporinas (2 mg/mL), tendo confirmado, por testes cutâneos positivos, a sensibilização à cefalosporina em todos os indivíduos.…”

Section: O Diagnóstico De Alergia Foi Confirmado E a Dessensibilização?unclassified

Allergy to beta-lactams in pediatrics: a practical approach

Grumach

2006

J Pediatr (Rio J)

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Objective: To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics.Sources: Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts.Summary of the findings: Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10% of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95%) and minor determinants (5%). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95% of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. Conclusions:The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.J Pediatr (Rio J). 2006;82(5 Suppl):S181-8: Beta-lactam, penicillin, cephalosporin, allergy, hypersensitivity reaction. ResumoObjetivo: Apresentar uma abordagem prática ao diagnóstico e conduta na alergia a antibióticos beta-lactâmicos.Fontes dos dados: Periódicos da área de alergia indexados nas bases MEDLINE e LILACS, além de estudos e textos clássicos que tratam do tema. Síntese dos dados:A alergia à penicilina é relatada com freqüên-cia, em muitos casos resultando na exclusão desse medicamento do arsenal terapêutico. Cerca de 10% dos relatos de alergia a drogas são confirmados. As manifestações clínicas decorrentes da reação alérgica à penicilina são bastante amplas, destacando-se os quadros cutâneos. Os quatro mecanismos de hipersensibilidade de Gell & Coombs estão envolvidos nas reações alérgicas. A penicilina é degradada em determinante maior (95% dos produtos) e em determinantes menores (5% dos produtos). As reações imediatas, mediadas por IgE, e que determinam quadros de anafilaxia, estão relacionadas aos determinantes menores em 95% dos casos. A hipersensibilidade a esses produtos pode ser avaliada através de testes cutâneos realizados com os determinantes maior e menores, permitindo, assim, evitar o choque anafilático em indivíduos alérgicos. O texto ressalta conhecimentos básicos sobre a alergia à penicilina, propiciando um diagnóstico mais adequado desse evento e a conduta em casos de suspeita de alergia a beta-lactâmicos.Conclusões: O diagnóstico de alergia à penicilina tem sido feito de forma inadequada, resultando em sua exclusão do arsenal terapêutico. O melhor reconhecimento dessas cond...

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Cross-reactivity between a penicillin and a cephalosporin with the same side chain☆, ☆☆, ★, ★★

Cited by 145 publications

References 21 publications

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

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

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Allergy to beta-lactams in pediatrics: a practical approach

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