Cross-reactivity between penicillins and cephalosporins: Clinical and immunologic studies

Blanca, Miguel; Fernández, J.; Miranda, A.; Terrados, S.; Torres, Marı́a José; Vega, José M.; Ávila, María José; Pérez, E.; Garcı́a, J.J.; Suau, Rafael

doi:10.1016/0091-6749(89)90122-x

Cited by 129 publications

(69 citation statements)

References 10 publications

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“…Initial studies indicated that IgE recognizing BP cross-react with some cephalosporins, such as cephalotin and cephaloridine, which contain a similar side chain to BP, but poorly with cefuroxime and cefotaxime, which have very different side chains. In fact, cross-reactivity of penicilllins with cephamandole and cephaloridine was reported in only 10 % of cases [15], increasing to nearly 40 % for AX and cefadroxil, which have identical R 1 side chains [9]. Similar results were detected between ampicillin and cephalexin, which also share the same R 1 side chain [57].…”

Section: Cephalosporin As An Alternative Treatmentsupporting

confidence: 72%

“…The initial incidence of penicillin and cephalosporin cross-reactivity was overestimated at nearly 50 % due to contamination of cephalosporins with penicillin traces [55]. However, this percentage has gradually decreased to 12 % since the 1980s [8,15,[56][57][58][59]. These studies also highlight the importance of the side-chain chemical structure for predicting cross-reactivity.…”

Section: Cephalosporin As An Alternative Treatmentmentioning

confidence: 76%

“…This was 3.5-6 % in patients with positive versus 0.6-0.7 % in those with negative penicillin skin test results [15,56,57,61]. This indicated a greater risk of an adverse drug reaction to cephalosporin in patients with a history of penicillin allergy and a positive penicillin skin test.…”

Section: Cephalosporin As An Alternative Treatmentmentioning

confidence: 84%

“…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%

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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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Section: Cephalosporin As An Alternative Treatmentsupporting

confidence: 72%

Section: Cephalosporin As An Alternative Treatmentmentioning

confidence: 76%

Section: Cephalosporin As An Alternative Treatmentmentioning

confidence: 84%

Section: Bl Immunological Recognitionmentioning

confidence: 99%

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Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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“…On the contrary, two of the 151 patients with allergic history but negative penicillin skin test reacted to cephalosporins, putting to doubt the value of penicillin skin test in predicting cross-reactivity to cephalosporins. 40 In another small cohort study by Blanca et al, 45 19 patients with confirmed penicillin hypersensitivity were given parenteral cephamandole, a second-generation cephalosporin, followed by oral cephaloridine, a first-generation cephalosporin, if the former was tolerated. Two (10.5%) of the 19 patients crossreacted with cephamandole while all the remaining 17 patients tolerated cephaloridine.…”

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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Is This Patient Allergic to Penicillin?

Salkind¹,

Cuddy²,

Foxworth³

2001

JAMA

232

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Only 10% to 20% of patients reporting a history of penicillin allergy are truly allergic when assessed by skin testing. Taking a detailed history of a patient's reaction to penicillin may allow clinicians to exclude true penicillin allergy, allowing these patients to receive penicillin. Patients with a concerning history of type I penicillin allergy who have a compelling need for a drug containing penicillin should undergo skin testing. Virtually all patients with a negative skin test result can take penicillin without serious sequelae.

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Cross-reactivity between penicillins and cephalosporins: Clinical and immunologic studies

Cited by 129 publications

References 10 publications

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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

Is This Patient Allergic to Penicillin?

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