IgE-Mediated Hypersensitivity to Cephalosporins

Abstract

Like penicillins, cephalosporins may cause IgE-mediated reactions such as urticaria, angioedema, and anaphylactic shock, which occur because of sensitization to determinants shared with penicillins or to unique cephalosporin haptens. In particular, side-chain structures may be responsible for selective sensitization or cross-reactivity. For this reason, individual free cephalosporins are usually employed in skin testing, in addition to the classic penicillin reagents. Cephalosporin skin tests are sensitive in diagnosing immediate hypersensitivity to these betalactams. As far as in vitro tests are concerned, IgE assays for cephalosporins, specifically sepharose-radioimmunoassays, are a potentially useful tool in evaluating immediate reactions and could be used as complementary tests. In selected cases displaying negative results in both skin tests and IgE assays, a graded challenge with the implicated cephalosporin can be performed. Cephalosporin IgE-mediated hypersensitivity may be a transient condition; therefore, allergologic exams should be repeated in patients with negative initial allergologic work-ups, including challenges. Performing allergologic tests with cephalosporins other than the culprit, as well as with penicillin reagents, allows the identification of cross-reactivity with penicillins, selective responses, or cross-reactivity among cephalosporins. In the latter group, cross-reactivity is more frequently related to R1 than to R2 side-chain recognition. In assessing the selectivity of the response, negative results in skin testing with cephalosporins other than the responsible one appear to be a reliable indicator of tolerability.

Diagnosis and Management of Immediate Hypersensitivity Reactions to Cephalosporins

“…During cephalosporin degradation, the rupture of the dihydrothiazine ring leads to expulsion of the R2 group. Thus, the intact R1 group appears to be more important for the cross-reactivity of cephalosporins, compared to the lost R2 group 5,9,22. Multiple case reports support these conclusions 11,47,48.…”

“…Cephalosporins can cause a range of hypersensitivity reactions from mild, cutaneous reactions to life-threatening anaphylaxis in patients with IgE-mediated allergy 1,2,3,4,5. As the number of cephalosporin prescriptions has increased, the prevalence of immediate hypersensitivity reactions to cephalosporins also appears to be on the rise 6.…”

IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of penicillins, monobactams, and carbapenems

“…5,6 Skin tests for parent cephalosporins are useful tools for evaluating subjects with immediate reactions to these b-lactams. [7][8][9][10][11][12] With regard to in vitro tests, except for cefaclor, assays of serum specific IgE are not commercially available and thus are not routinely used. 6 A number of studies have evaluated allergic cross-reactivity with cephalosporins in large samples of subjects with welldemonstrated IgE-mediated hypersensitivity to penicillins.…”

Ceftriaxone-Induced Fatal Anaphylaxis Shock at an Emergency Department: A Case Report

“…[5] Anaphylaxis can happen in patients with immunoglobulin E-mediated allergy. [6,7] Anaphylaxis is an acute life threatening reaction. Antibiotic skin testing is not normally done in a patients without a history of allergy including food allergy.…”