Penicillin and Cephalosporin allergy

Pichichero, Michael E.; Zagursky, Robert J.

doi:10.1016/j.anai.2014.02.005

Cited by 101 publications

(79 citation statements)

References 71 publications

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“…However, in those with a previous IgE-mediated reaction to penicillin, oral cephalosporins with similar side chains to the implicated penicillin agent (e.g. ampicillin and cefalexin or cefaclor) should be avoided [65,66]. In addition, this review recommended that investigations for an underlying cause should be undertaken in the small group of children who, despite adhering to their treatment, fail the 4-week course of antibiotic therapy [47,57].…”

Section: Therapy (Kq6)mentioning

confidence: 99%

ERS statement on protracted bacterial bronchitis in children

et al. 2017

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This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.This article has supplementary material available from

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Section: Therapy (Kq6)mentioning

confidence: 99%

ERS statement on protracted bacterial bronchitis in children

et al. 2017

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“…Beta-lactams are recognized as one of the most frequent causes of immediate and non-immediate drug reactions [10][11][12]. The prevalence of penicillin hypersensitivity in the general population is unknown as there are no prospective studies evaluating sensitization rates during treatment [13].…”

Section: Epidemiology In Adultsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

228

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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“…For example, if someone reacts to the amino side chain of amoxicillin rather than the beta-lactam core structure, they are likely to have a cross-reactive allergy to ampicillin which shares a very similar side chain, but not to benzylpenicillin or other penicillins. 10 Antigenic determinants for cephalosporin hypersensitivity have only recently become better defined. The cephalosporin R2 side chain is usually lost after the opening of the beta-lactam ring, so is less likely to cause allergy (Fig.…”

Section: Cross-reactive Side Chainsmentioning

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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Penicillin and Cephalosporin allergy

Cited by 101 publications

References 71 publications

ERS statement on protracted bacterial bronchitis in children

ERS statement on protracted bacterial bronchitis in children

Management of allergy to penicillins and other beta‐lactams

Cephalosporin allergy label is misleading

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