Immediate cephalosporin allergy

Yuson, Carlo; Kumar, K. Anbu; Le, A; Ahmadie, Aida; Banovic, Tatjana; Heddle, Richard; Kette, Frank; Smith, William B.; Hissaria, Pravin

doi:10.1111/imj.14229

Cited by 19 publications

(22 citation statements)

References 36 publications

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“…Historically, patients with a penicillin allergy were thought to have contraindications to cephalosporin therapy due to high rates of cross-reactivity [46,64]. However, new more recent data suggests patients with a history of penicillin allergy are roughly 1–4% will have a true cephalosporin allergy [2,3]. Additionally, some experts hypothesize that contamination of pre-1980 cephalosporins with trace amounts of benzylpenicillin may have led to an overestimation of the degree of cross-reactivity between cephalosporins and penicillins [65].…”

Section: Incidence Of Cephalosporin Allergiesmentioning

confidence: 99%

“…Cephalosporins are a commonly prescribed class of antibiotics in inpatient and community settings due to their clinical utility in a number of infectious disease states. While only 1–3% of the population report a cephalosporin allergy [1,2,3,4], patient-reported or poorly described β-lactam allergies represent a barrier to receiving cephalosporin therapy due to misconceptions related to cross-reactivity. Common clinical practice is to avoid other β-lactam classes, including cephalosporins, in patients with a labeled β-lactam allergy [5].…”

Section: Introductionmentioning

confidence: 99%

“…Common clinical practice is to avoid other β-lactam classes, including cephalosporins, in patients with a labeled β-lactam allergy [5]. Additionally, true IgE-mediated allergies are relatively rare and electronic medical record descriptions of β-lactam allergies are often lacking or incomplete [3,5,6,7,8,9]. Most literature suggests that 99% of these patients do not have a true allergy and can safely receive β-lactam antibiotics [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

2019

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Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy; however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.

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Section: Incidence Of Cephalosporin Allergiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

2019

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“…14,15 Almost 30% of frail patients in this study had a Charlson index of comorbidity of zero, consistent with previous work that found frailty occurs in around a quarter of patients in the absence of comorbid disease and disability. 16…”

Section: Relationship To Previous Workmentioning

confidence: 99%

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Smith

Reid

Santamaria

2019

Internal Medicine Journal

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Background Frailty is common among acute hospital patients and might adversely affect recovery from inpatient cardiac arrest. Aim To assess the relationship between hospital admission characteristics, including frailty, and discharge outcome after in‐hospital cardiac arrest. Methods Prospectively collected data were retrospectively analysed for all separations from a tertiary hospital during 2008–2017 that involved rapid response team attendance for cardiac arrest. Hospital Frailty Risk Score (HFRS) and Charlson index of comorbidity were calculated from ‘primary’ and ‘associated’ International Classification of Diseases, 10th revision, Australian Modification diagnoses. HFRS ≥5 was taken to signify frailty. Discharge home from hospital and death in hospital were modelled using logistic regression. Results There were 388 in‐hospital arrest patients: 91% were aged ≥50 years, 34% were previously discharged in the past 6 months, 66% were unplanned admissions, 63% were non‐cardiology‐cardiothoracic admissions, 45% had a Charlson comorbidity index ≥2 and 19% were identified as frail. Discharge home occurred in 22%, discharge to another hospital 17% and death 62%. Of the frail patients, only 3 (4%) were discharged home, 12 (17%) were discharged to another hospital and 57 (79%) died in hospital. Fewer frail patients were discharged home compared with non‐frail patients (4 vs 26%; odds ratio (OR) 0.13, P = 0.001). On multivariable analysis, patients were less likely to be discharged home if they had frailty (OR 0.24, P = 0.02), age ≥ 50 years (OR 0.36, P = 0.01), non‐cardiology‐cardiothoracic unit admission (OR 0.40, P = 0.001) and unplanned admission (OR 0.57, P = 0.04). Frail patients discharged to another hospital spent a median of 15 days (interquartile range 11–23) in the hospital post‐arrest before leaving to continue inpatient care elsewhere. Frailty was associated with death in hospital on univariate analysis (79 vs 58%; OR 2.80, P = 0.001) but not after controlling for other factors. Conclusion Frail patients are unlikely to make a good recovery after in‐hospital arrest. This should be taken into account when planning care with patients and their families.

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“…On the other hand, anaphylactic shock is rarely described (approximately 0.0001-0.1%) as well as fatalities [11,12], in subjects with beta-lactam allergies. In particular, anaphylactic reactions following the administration of specific cephalosporins are reported and related to penicillins-cephalosporins' or cephalosporins' cross-reactivity [13].…”

Section: Introductionmentioning

confidence: 99%

Cephalosporins’ Cross-Reactivity and the High Degree of Required Knowledge. Case Report and Review of the Literature

et al. 2020

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Antibiotic cross-reactivity represents a phenomenon of considerable interest as well as antibiotic resistance. Immediate reactions to cephalosporins are reported in the literature with a prevalence of only 1–3% of the population, while anaphylactic reactions are rarely described (approximately 0.0001–0.1%) as well as fatalities. Allergic reaction to cephalosporins may occur because of sensitization to unique cephalosporin haptens or to determinants shared with penicillins. Cross-reactivity between cephalosporins represents, in fact, a well-known threatening event involving cephalosporins with similar or identical R1- or R2-side chains. The present report describes the case of a 79-year-old man who suddenly died after intramuscular administration of ceftriaxone. Serum dosage of mast cell tryptase from a femoral blood sample at 3 and 24 h detected values of 87.7μg/L and 93.5μg/L, respectively (cut-off value 44.3 μg/L); the serum-specific IgE for penicillins, amoxicillin, cephaclor and also for the most common allergens were also determined. A complete post-mortem examination was performed, including gross, histological and immunohistochemical examination, with an anti-tryptase antibody. The cause of death was identified as anaphylactic shock: past administrations of cefepime sensitized the subject to cephalosporins and a fatal cross-reactivity of ceftriaxone with cefepime occurred due to the identical seven-position side chain structure in both molecules. The reported case offers food for thought regarding the study of cross-reactivity and the need to clarify the predictability and preventability of the phenomenon in fatal events.

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Immediate cephalosporin allergy

Cited by 19 publications

References 36 publications

Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

Cephalosporins: A Focus on Side Chains and β-Lactam Cross-Reactivity

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

Cephalosporins’ Cross-Reactivity and the High Degree of Required Knowledge. Case Report and Review of the Literature

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