Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center

Beltran, Ralph J; Kako, Hiromi; Chovanec, Thomas; Ramesh, Archana; Bissonnette, Bruno; Tobias, Joseph D.

doi:10.1016/j.jpedsurg.2014.10.048

Cited by 64 publications

(44 citation statements)

References 10 publications

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“…Surgical antibiotic prophylaxis results in significant antibiotic exposure among children. 6,9 Despite evidence that cefazolin is safe to use in children with a non-life-threatening penicillin ADR history, many clinicians remain reluctant. Ideally, cefazolin would be selected when indicated because it is narrow-spectrum and well tolerated and has been extensively studied.…”

Section: Discussionmentioning

confidence: 99%

Variability of surgical prophylaxis in penicillin-allergic children

Butler

Lee

Suppes

et al. 2018

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

Variability of surgical prophylaxis in penicillin-allergic children

Butler

Lee

Suppes

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…The four patients who had reported a prior reaction to a cephalosporin did not require an antibiotic on this admission. While there can be some uneasiness around using cephalosporins in penicillin allergic patients, cephalosporins have been used safely in patients with a penicillin allergy label perioperatively . In the wider healthcare setting, the risk of anaphylaxis appears similar to nonpenicillin allergy patients .…”

Section: Discussionmentioning

confidence: 99%

“…While there can be some uneasiness around using cephalosporins in penicillin allergic patients, cephalosporins have been used safely in patients with a penicillin allergy label perioperatively. 28,29 In the wider healthcare setting, the risk of anaphylaxis appears similar to nonpenicillin allergy patients. 30 Further with its unique R1 side chain, cephazolin may result in a selective hypersensitivity not a class hypersensitivity as reactions can occur to it without cross-reactivity with penicillins, cephalosporins, or other betalactams.…”

Section: Discussionmentioning

confidence: 99%

Allergy alerts — The incidence of parentally reported allergies in children presenting for general anesthesia

Sommerfield

Schilling

et al. 2018

Pediatric Anesthesia

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Summary Background and aim Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent‐reported allergies in children presenting for surgery and its significance for anesthetists. Methods We prospectively collected data on admissions through our surgical admission unit over a 2‐month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anesthetist reviewed the documentation of all patients reporting an allergy. Results We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent‐reported allergies; to medications/drugs (n = 73), food (n = 66), environmental allergens (dust/grasses, n = 35), tapes/dressings (n = 27), latex (n = 4), and venom (eg, bee, wasp, n = 9). Forty‐one patients reported antibiotic allergies, with Beta‐lactam antibiotics being the most common, with the majority presenting with rash alone (57%). Ten patients reported allergies to nonsteroidal anti‐inflammatory drugs and eight to opioids. Twenty‐four patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE‐mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow‐up. Just four patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anesthesia practice. Conclusion Only the minority of parent‐reported allergies in pediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self‐reported food allergy is commonly specialist verified whereas reactions to medications were generally not. Over‐reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent‐reported reactions is urgently needed.

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“…However, we sometimes use vancomycin for patients with a history of penicillin allergy, a practice that perhaps should be abandoned. There is, in fact, little risk that a patient with a reported allergy to penicillin will experience anaphylaxis when given cefazolin [3,14].…”

mentioning

confidence: 99%

“…Wongworawat: Given the low risk of cross-reactivity in beta-lactam allergy with cephalosporins and the inferior effectiveness of vancomycin as a sole prophylactic agent, can you outline your decision algorithm for antibiotic dosing in patients who undergo arthroplasty? Dr. Kheir: Patient-reported penicillin allergy has important consequences for antibiotic selection, as cephalosporin agents normally used for perioperative prophylaxis are avoided due to the potential for cross-reactivity, even though the associated risks are unclear [3,8,15]. Of consequence, administering suboptimal antibiotics can increase the risk of infection in these patients [5,13,18,22].…”

mentioning

confidence: 99%

Editor's Spotlight/Take 5: Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Wongworawat

2017

Clinical Orthopaedics &Amp; Related Research

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Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center

Cited by 64 publications

References 10 publications

Variability of surgical prophylaxis in penicillin-allergic children

Variability of surgical prophylaxis in penicillin-allergic children

Allergy alerts — The incidence of parentally reported allergies in children presenting for general anesthesia

Editor's Spotlight/Take 5: Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

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