Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

Mota, Inês; Gáspár, Angéla; Morais‐Almeida, Mário

doi:10.1159/000490182

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…After an initial screening of titles and abstracts, a total of 467 articles were removed. Of the remaining 68 studies, a total of 25 articles were included after full-text screening ( 8 – 32 ). Patient information is summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin

Fang

Song

Deng

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCephalosporins are an increasingly encountered cause of Kounis syndrome. The present study examined the clinical features of cephalosporin-induced Kounis syndrome and provided references for diagnosis, prevention, treatment, and prognosis.MethodsWe collected cephalosporin-induced Kounis syndrome case reports by searching Chinese and English databases from the establishment of the database to October 31, 2021.ResultsTwenty-five patients (17 males and eight females) were included, with a median age of 61 years (range 33–92). Cephalosporins were administered via oral, intravenous and intramuscular routes. All reactions occurred within 30 min, except in two patients. Fourteen patients experienced chest pain, 19 experienced hypotension, 16 had cutaneous reactions, 10 had respiratory symptoms, and seven had gastrointestinal symptoms. Thirteen patients had elevated troponin levels, and eight patients had elevated serum tryptase levels. The electrocardiogram showed ST-segment elevation in 13 patients, depression in four patients, and elevation and depression in six patients. Coronary angiography showed normal results in 12 patients and abnormal results in 13 patients. The skin prick test was positive for cephalosporin in three patients. Twenty-four of the 25 patients recovered after being given anti-allergic and acute coronary syndrome treatment, and there was one death.ConclusionsKounis syndrome is a serious adverse reaction to cephalosporin. Clinicians should consider Kounis syndrome in every patient receiving cephalosporin and presenting with acute chest pain or anaphylactic symptoms.

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Section: Resultsmentioning

confidence: 99%

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin

Fang

Song

Deng

et al. 2022

Front. Cardiovasc. Med.

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“…We included 15 primary studies that assessed the frequency of penicillin allergy in series of patients with cefazolin allergy (Table 2). The included primary studies assessed a total of 146 participants. All patients had confirmed cefazolin allergy.…”

Section: Resultsmentioning

confidence: 99%

“…All patients had confirmed cefazolin allergy. Seven studies included only patients who had had anaphylactic reactions to cefazolin. Penicillin allergy was assessed by means of drug challenge or exposure in 9 studies .…”

Section: Resultsmentioning

confidence: 99%

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

et al. 2021

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IMPORTANCE Cefazolin is the preoperative antibiotic of choice because it is safer and more efficacious than second-line alternatives. Surgical patients labeled as having penicillin allergy are less likely to prophylactically receive cefazolin and more likely to receive clindamycin or vancomycin, which results in higher rates of surgical site infections.OBJECTIVE To examine the incidence of dual allergy to cefazolin and natural penicillins.DATA SOURCES MEDLINE/PubMed, Web of Science, and Embase were searched without language restrictions for relevant articles published from database inception until July 31, 2020.STUDY SELECTION In this systematic review and meta-analysis, a search of MEDLINE/PubMed, Web of Science, and Embase was performed for articles published from database inception to July 31, 2020, for studies that included patients who had index allergies to a natural penicillin and were tested for tolerability to cefazolin or that included patients who had index allergies to cefazolin and were tested for tolerability to a natural penicillin. A total of 3228 studies were identified and 2911 were screened for inclusion.DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 authors. Bayesian meta-analysis was used to estimate the frequency of allergic reactions. MAIN OUTCOMES AND MEASURESDual allergy to cefazolin and a natural penicillin. RESULTSSeventy-seven unique studies met the eligibility criteria, yielding 6147 patients. Cefazolin allergy was identified in 44 participants with a history of penicillin allergy, resulting in a dual allergy meta-analytical frequency of 0.7% (95% credible interval [CrI], 0.1%-1.7%; I 2 = 74.9%). Such frequency was lower for participants with unconfirmed (0.6%; 95% CrI, 0.1%-1.3%; I 2 = 54.3%) than for those with confirmed penicillin allergy (3.0%; 95% CrI, 0.01%-17.0%; I 2 = 88.2%). Thirteen studies exclusively assessed surgical patients (n = 3884), among whom 0.7% (95% CrI, 0%-3.3%; I 2 = 85.5%) had confirmed allergy to cefazolin. Low heterogeneity was observed for studies of patients with unconfirmed penicillin allergy who had been exposed to perioperative cefazolin (0.1%; 95% CrI, 0.1%-0.3%; I 2 = 13.1%). Penicillin allergy was confirmed in 16 participants with a history of cefazolin allergy, resulting in a meta-analytical frequency of 3.7% (95% CrI, 0.03%-13.3%; I 2 = 64.4%). The frequency of penicillin allergy was 4.4% (95% CrI, 0%-23.0%; I 2 = 75%) for the 8 studies that exclusively assessed surgical patients allergic to cefazolin.CONCLUSIONS AND RELEVANCE These findings suggest that most patients with a penicillin allergy history may safely receive cefazolin. The exception is patients with confirmed penicillin allergy in whom additional care is warranted.

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“…Literature also provides description of case reports of KS associated with ICM 1,2,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and with hymenoptera stings. [46][47][48][49][50][51][52][53][54] Note that only few subjects with KS related to drugs and hymenoptera stings underwent allergy tests, particularly STs, and presented positive results to the culprit drugs, specifically, amoxicillin, [55][56][57][58] ceftriaxone, 59 cefazolin, [60][61][62][63][64] cefuroxime, 65 ICM 37,44 or to hymenoptera venoms. 49,54 In patients with drug allergy and PEA we didn't perform STs thinking that in this type of patients at higher risk skin testing may result in systemic response.…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Kounis syndrome: an underestimated emergency

Zisa¹,

Panero²,

Re³

et al. 2023

Eur Ann Allergy Clin Immunol

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Background: Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. Objectives:To establish the prevalence of KS among the patients with diagnosis of anaphylaxis and describe clinical features, cardiological and allergological outcomes of patients evaluated in our Allergy Outpatient Clinic. Methods: A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents.Results: We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to hymenoptera stings, 5/9 to drugs). Conclusions:The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

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Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

Cited by 12 publications

References 21 publications

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

Kounis syndrome: an underestimated emergency

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