Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Dickson, Scott D.; Salazar, Kimberly C.

doi:10.1007/s12016-013-8367-x

Cited by 47 publications

(55 citation statements)

References 69 publications

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“…Allergic reactions to cephalosporins have been considered primarily in conjunction with penicillin allergy. However, cephalosporin allergy can occur to a specific cephalosporin, a group of cephalosporins, or as a cross-reaction to other β-lactam antibiotics 3,6,7,8,9,10,11,12…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Kim

Lee

2014

Allergy Asthma Immunol Res

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Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other β-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.

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Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Kim

Lee

2014

Allergy Asthma Immunol Res

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“…19 Skin prick, intradermal (early or delayed) and patch testing are more sensitive than immunoassays, however their negative predictive values are not established due to a lack of sufficiently powered studies. 20 Several cephalosporins are not available in a solution suitable for skin testing due to poor solubility, and the diagnostic value of extemporaneously prepared solutions has not been established. Skin-test sensitivity to cephalosporins can decrease over time 21 which complicates interpretation.…”

Section: Investigationsmentioning

confidence: 99%

Cephalosporin allergy label is misleading

Yuson¹,

Katelaris²,

Smith³

2018

Aust Prescr

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SUMMARYPenicillins and cephalosporins can cause a similar spectrum of allergic reactions at a similar rate.Cross-reactive allergy between penicillins and cephalosporins is rare, as is cross-reaction within the cephalosporin group. Patients should therefore not be labelled 'cephalosporin-allergic'.Cross-reactive allergy may occur between cephalosporins (and penicillins) which share similar side chains.Generally, a history of a penicillin allergy should not rule out the use of cephalosporins, and a history of a specific cephalosporin allergy should not rule out the use of other cephalosporins.Specialist advice or further investigations may be required when the index reaction was anaphylaxis or a severe cutaneous adverse reaction, or when the antibiotics in question share common side chains.When recording a drug allergy in the patient's records, it is important to identify the specific drug suspected (or confirmed), along with the date and nature of the adverse reaction. Records need to be updated after a negative drug challenge. 'Cephalosporin allergy' label is misleadingas Stevens-Johnson syndrome, toxic epidermal necrolysis or acute generalised exanthematous pustulosis or organ hypersensitivity). Structural chemistry and allergyImmunological reactivity to small molecules such as antibiotics depends on the formation of haptens. These are stable covalent complexes of the drug with larger carrier molecules such as serum or membrane proteins. For penicillin, this occurs when the betalactam ring spontaneously opens to form penicilloyl which binds to lysine residues on host proteins. Beta-lactam ringCephalosporins and penicillins share the four-atom beta-lactam ring structure. In penicillins the betalactam ring is linked to a five-member thiazolidine ring whereas in cephalosporins it is linked to the dihydrothiazine ring (see Figs 1 and 2).It was previously thought that people allergic to penicillins had a high likelihood of allergy to any cephalosporins (reportedly up to 23.9%).7 More recent studies have demonstrated cross-reactivity rates as low as 1%. 8The common beta-lactam ring is the putative reason for potential cross-reactivity between penicillins and cephalosporins. However, there is in fact little theoretical basis for this. Penicillins are chemically reactive due to a high degree of tension between the beta-lactam ring and the thiazolidine ring, whereas the cephalosporin beta-lactam ring forms a more IntroductionTo label an individual with a 'cephalosporin allergy' is misleading. Given the structural diversity of the cephalosporin family, hypersensitivity is seldom a class effect but is much more likely to relate to the individual drug. Cross-reactivity within the family is very limited and is more likely to relate to the side chain than the core structure.1 A greater awareness of this in clinical practice would lead to the availability of alternative cephalosporins and prevent unnecessary use of other classes of broad-spectrum antibiotics.Cephalosporins were first introduced in the 1960s, 2 and are one of...

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“…19 Ceftriaxone, a third-generation semisynthetic cephalosporin antibiotic, is used for an ample variety of infectious diseases. Different types of adverse reactions are reported to be induced by ceftriaxone.…”

Section: Discussionmentioning

confidence: 99%

Fatal Anaphylactic Shock Ceftriaxone-Induced in a 4-Year-Old Child

Calapai¹,

Imbesi²,

Ventura-Spagnolo³

et al. 2016

Pediatric Emergency Care

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One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

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Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Cited by 47 publications

References 69 publications

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Cephalosporin allergy label is misleading

Fatal Anaphylactic Shock Ceftriaxone-Induced in a 4-Year-Old Child

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