Diagnosing Hypersensitivity Reactions to Cephalosporins in Children

Romano, Antonino; Gaeta, Francesco; Valluzzi, Rocco Luigi; Alonzi, Cristiana; Viola, Marinella; Bousquet, Philippe‐Jean

doi:10.1542/peds.2007-3178

Cited by 94 publications

(71 citation statements)

References 26 publications

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“…Most are non-immediate cutaneous reactions, occurring >1 h following administration of a dose, of mild to moderate severity, in children below 4 years of age [226,227,229]. There are no predisposing risk factors for beta-lactam allergy in children, and only a minority (7-16%) of children with suspected beta-lactam hypersensitivity are found to be allergic following investigation [225,230].…”

Section: Epidemiologymentioning

confidence: 99%

“…The role of specific IgE in children with immediate reactions to beta-lactams requires further evaluation [229]. In children with non-immediate reactions, measurement of specific IgE is not useful [225].…”

Section: Specific Igementioning

confidence: 99%

“…Oral drug challenges are safe in children without a history of anaphylaxis and should be considered in all children who develop a rash. Fewer than 7% of children are allergic on re-exposure [225,226,229]. Reactions are usually mild to moderate and less severe than the index event and resolve with oral antihistamines and/or oral corticosteroids [225,230].…”

Section: Oral Challenge Testingmentioning

confidence: 99%

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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: Epidemiologymentioning

confidence: 99%

Section: Specific Igementioning

confidence: 99%

Section: Oral Challenge Testingmentioning

confidence: 99%

See 1 more Smart Citation

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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“…5 Studies generally have shown low sensitivity and positive predictive value. 64,65 Nevertheless, skin test for BL hypersensitivity is still considered 'good' by the International Consensus in 2014. 60 Patients with negative cephalosporin skin test should pass a DPT before finally receiving a cephalosporin.…”

Section: Ten Per Cent Cross-reactivity: An Over-estimationmentioning

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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“…Ceftriaxone is a third-generation cephalosporin antibiotic that has broad spectrum activity against Gram-negative and Gram-positive bacteria (2). Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, edema, erythema, maculopapular rash and anaphylactic shock (2,3), to the best of our knowledge, there is no report about whether ceftriaxone gives rise to allergenic acute coronary syndrome or not. Here, we define a case of severe CAS, culminating in acute inferior myocardial infarction (MI), as the result of an acute allergenic reaction, which was likely related to ceftriaxone use.…”

Section: Introductionmentioning

confidence: 99%

A Case of Coronary Spasm with Resultant Acute Myocardial Infarction: Likely the Result of an Allergic Reaction

Yurtdaş

Aydın

2012

Intern. Med.

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Kounis syndrome has been known as allergenic angina and/or allergenic myocardial infarction following an allergic reaction. Probable allergic insults usually include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, as far as we know, there is no published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe the first report of allergic vasospasm, culminating in acute inferior myocardial infarction, probably as the result of an acute allergenic reaction, after ceftriaxone use.

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Diagnosing Hypersensitivity Reactions to Cephalosporins in Children

Abstract: Extremely few nonimmediate manifestations associated with cephalosporin therapy are actually hypersensitivity reactions, whereas most immediate reactions to cephalosporins are IgE-mediated. Cephalosporin skin testing is a useful tool for evaluating such reactions.

Cited by 94 publications

References 26 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

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

A Case of Coronary Spasm with Resultant Acute Myocardial Infarction: Likely the Result of an Allergic Reaction

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