Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

Abstract

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.

Cefazolin Hypersensitivity: Toward Optimized Diagnosis

“…12 The R1 side chain of cefazolin consists of a heterocycle N-methylthiodiazole structure 13 that is different to other cephalosporin R1 side chains. 8,12,27 In conclusion, our study demonstrates that diagnosis of cefazolin hypersensitivity benefits from a drug-specific intradermal test concentration of up to 20 mg/mL. Furthermore, the study of cross-reactivity reveals that, according to literature data, cefazolin hypersensitivity in the great majority of cases is a selective allergy with tolerance to other b-lactam antibiotics.…”

“…Therefore, clinical suspicion of cefazolin hypersensitivity is generally confirmed with skin tests. 8 However, for the time being, skin testing with cephalosporins is not entirely standardized and optimal skin test concentrations remain to be established. 8 Actually, sensitivity, specificity, and predictive values of this diagnostic method remain unknown, mainly because the maximal nonirritating skin test concentrations need to be established.…”

“…8 However, for the time being, skin testing with cephalosporins is not entirely standardized and optimal skin test concentrations remain to be established. 8 Actually, sensitivity, specificity, and predictive values of this diagnostic method remain unknown, mainly because the maximal nonirritating skin test concentrations need to be established. To date, the European Network on Drug Allergy (ENDA) recommends a maximal nonirritating skin test concentration of 2 mg/mL for all the cephalosporins.…”

Clinical characteristics of adverse events associated with therapeutic monoclonal antibodies in Korea

“…Biological agents may also differ from xenobiotics with regard to the clinical features of their adverse reactions . The disease for which the drug has been prescribed and concomitant treatments can both influence the adverse reactions to biological agents .…”

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

“…Since there is no reliable cefazolin-specific IgE antibody assay, clinical suspicion of cefazolin hypersensitivity is generally confirmed by skin tests [12]. Although skin tests with cephalosporins are not as well established as with those with penicillin, several studies have demonstrated their usefulness for the diagnosis of immediate reactions [5, 6, 13].…”