Safe use of selected cephalosporins in penicillin‐allergic patients: A meta‐analysis

Pichichero, Michael E.; Casey, Janet R.

doi:10.1016/j.otohns.2006.10.007

Cited by 165 publications

(124 citation statements)

References 43 publications

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“…The majority (approximately 70%) of anaphylaxis caused by antibiotics in human medicine result from penicillins and cephalosporins (e.g. cefazolin, used in this case), which share the beta-lactam ring and are typically mediated by IgE (Harper et al 2009, Pichichero andCasey 2007).…”

Section: Discussionmentioning

confidence: 99%

Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog

Prebble¹,

Pang

2016

Preprint

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A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.

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Section: Discussionmentioning

confidence: 99%

Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog

Prebble¹,

Pang

2016

Preprint

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“…However, one (0.7%) of the 152 patients with negative skin test had an immediate allergic reaction after cephalexin, underscoring the lack of predictive power of the penicillin skin test. 50 In a meta-analysis by Pichichero 15 There was a trend towards increased risk for firstgeneration cephalosporins, although the result did not reach statistical significance.…”

Section: Clinical Reaction To Cephalosporins In Patients With Penicilmentioning

confidence: 99%

“…The resulting unstable metabolites do not allow haptenisation of proteins. 15 In subjects with BL hypersensitivity, the hapten-protein conjugate has the capability to activate T-cells and the ensuing B-cell response. Specific immunoglobulin (Ig) E antibodies produced by B-cells become attached to the surface of effector cells such as mast cells and basophils.…”

Section: Mechanism Of Beta-lactam Hypersensitivitymentioning

confidence: 99%

“…22 Human studies have provided insight into the role of similarity in the R1 side-chains in causing BL cross-reactivity. 15 For instance, the 2-amino-2-phenylacetic acid side-chain in ampicillin is also present in first-or second-generation cephalosporins like cephalexin and cefaclor, respectively, but is absent in third-or fourth-generation cephalosporins. Similarly, the same 2-amino-2-(4-hydroxyphenyl) acetic acid side-chain is present in amoxicillin and cefadroxil but not in new generations of cephalosporins.…”

Section: Mechanism Of Cross-reactivity and The Side-chain Hypothesismentioning

confidence: 99%

“…In a landmark meta-analysis in 2007, Pichichero and Casey 15 reviewed nine studies that compared allergic reaction rate to cephalosporins in patients with or without penicillin allergy. Among 47 284 patients with a history of penicillin allergy alone, the odds ratio (OR) for cephalosporin cross-reactivity in general was 2.63 (95% CI, 2.11-3.28; P<0.00001).…”

Section: Clinical Reaction To Cephalosporins In Patients With a Histomentioning

confidence: 99%

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Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

Qu¹

2014

Hong Kong Med J

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A 10% cross-reactivity rate is commonly cited between penicillins and cephalosporins. However, this figure originated from studies in the 1960s and 1970s which included first-generation cephalosporins with similar side-chains to penicillins. Cephalosporins were frequently contaminated by trace amount of penicillins at that time. The sidechain hypothesis for beta-lactam hypersensitivity is supported by abundant scientific evidence. Newer generations of cephalosporins possess side-chains that are dissimilar to those of penicillins, leading to low cross-reactivity. In the assessment of crossreactivity between penicillins and cephalosporins, one has to take into account the background betalactam hypersensitivity, which occurs in up to 10% of patients. Cross-reactivity based on skin testing or in-vitro test occurs in up to 50% and 69% of cases, respectively. Clinical reactivity and drug challenge test suggest an average cross-reactivity rate of only 4.3%. For third-and fourth-generation cephalosporins, the rate is probably less than 1%. Recent international guidelines are in keeping withUse of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited The ten per cent myth about betalactam cross-reactivityPenicillins and cephalosporins are two groups of widely prescribed antibiotics. They belong to the class of beta-lactam (BL) antibiotics because both possess the same BL nucleus. Allergic reactions are common side-effects of BL antibiotics. Studies in the 1960s and 1970s frequently estimated 10% crossreactivity between penicillins and cephalosporins. 1,2 However, at least two recent reviews showed much lower cross-reactivity. 3,4 Notably, cross-reactivity is higher between penicillins and first-and secondgeneration cephalosporins compared with thirdand fourth-generation cephalosporins. 5 The latter two groups are considered safe alternatives for patients with penicillin hypersensitivity. 6 The 10% cross-reactivity rate has recently been questioned as a medical myth. 4,7 Yet until 2005, an influential drug reference such as the British National Formulary (BNF) abided by the "10% rule". 8 Faced with such recommendation, an ordinary physician naturally avoids all BL antibiotics in patients with a history

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Treatment of Syphilis

Clement

Okeke

Hicks

2014

JAMA

236

102

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Safe use of selected cephalosporins in penicillin‐allergic patients: A meta‐analysis

Abstract: First-generation cephalosporins have cross-allergy with penicillins, but cross-allergy is negligible with second- and third-generation cephalosporins. Particular emphasis should be placed on the role of chemical structure in determining the risk of cross-reactivity between specific agents.

Cited by 165 publications

References 43 publications

Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog

Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog

Use of cephalosporins in patients with immediate penicillin hypersensitivity: cross-reactivity revisited

Treatment of Syphilis

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