Allergic reactions to betalactams: studies in a group of patients allergic to penicillin and evaluation of cross‐reactivity with cephalosporin

Audícana, M.; Bernaola, G.; Urrutia, I.; Echechipía, S.; Gastaminza, G; Muñoz, D.; Fernández, Enrique Macías; Corrés, L. Fernández de

doi:10.1111/j.1398-9995.1994.tb00809.x

Cited by 141 publications

(104 citation statements)

References 17 publications

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“…In addition, skin testing can be a useful tool in distinguishing allergy and guiding antibiotic selection. Although skin testing penicillin-allergic patients cannot reliably predict an allergic response to cephalosporins with dissimilar side chains such as cefazolin, it can help identify whether a true allergy to penicillin exists in patients with a reported hypersensitivity, because a negative test result can reliably predict who can receive the antibiotic [3,9,14,15].…”

Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. Questions/purposes (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy?Methods We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between b-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. Results After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI,; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI,

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Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Most of the papers published on the usefulness of prick tests and IDT concern CADR due to betalactam antibiotics (1,24,29,(52)(53)(54). Prick tests and IDT have also been performed with other drugs such as diltiazem (45), heparin derivatives (33)(34)(35), insulin (45), oestradiol (1) and corticosteroids (56).…”

Section: Prick Tests and Idtmentioning

confidence: 99%

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

et al. 2001

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Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10-4, 10-3, 10-2, 10-1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false-positive results.

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“…The initial incidence of penicillin and cephalosporin cross-reactivity was overestimated at nearly 50 % due to contamination of cephalosporins with penicillin traces [55]. However, this percentage has gradually decreased to 12 % since the 1980s [8,15,[56][57][58][59]. These studies also highlight the importance of the side-chain chemical structure for predicting cross-reactivity.…”

Section: Cephalosporin As An Alternative Treatmentmentioning

confidence: 92%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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Opinion statementIt was originally thought that, as all betalactams share a four-member ring, they would cross-react, and so the classical recommendation was for allergic patients to avoid all betalactams. However, later studies found that some individuals selectively responded to one betalactam only and tolerated others. This was shown to be more frequent than initially thought, and this finding has led to a change from the initial recommendations of complete avoidance. Selective responses to amoxicillin are mainly due to recognition of the side chain structure, making benzylpenicillin a safe alternative. These amoxicillin-selective responders comprise up to 55 and 90 % of patients with immediate allergic reactions to amoxicillin and amoxicillin-clavulanic, respectively. Additionally, more than 85 % of penicillin-allergic patients can tolerate cephalosporins with different R 1 side chains, decreasing to 65 % if the side chain is identical. It is known that third and fourth generation cephalosporins are well tolerated by penicillin-allergic patients, probably because their chemical structures differ more from penicillins that those from the first generation. In patients with IgE-mediated allergic reactions to cephalosporins, penicillins can be an alternative treatment in up to 75 % of cases. Moreover, 40 % of patients primarily sensitized to a given cephalosporin also react to others, which might be because some cephaloporins have the same (ceftriaxone and cefotaxime) or very similar (ceftriaxone and cefuroxime) side chain structures. Finally, carbapenems and monobactams are good alternative for patients with penicillin and/or cephalosporin allergy because cross-reactivity occurs in G1 % of these cases. For all betalactams, tolerance is higher in T-cell-mediated reactions than IgE-mediated. These results show that alternative treatments for infectious disease are available to patients with allergic reactions to betalactams, from within the same group of antibiotics. Nevertheless, this general rules need to be analyzed patient by patient, and skin tests and graded challenge with the betalactam that is going to be administered are recommended. Keypoints• Patients with IgE-or T-cell-mediated allergy to betalactams can have selective reactions, specific to one betalactam with good tolerance to others, or be crossreactive, recognizing several different chemically related betalactams.• The percentage of selective reactions to the different betalactam compounds is higher than previously reported and patients should be studied in order to increase the treatment options available.

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Allergic reactions to betalactams: studies in a group of patients allergic to penicillin and evaluation of cross‐reactivity with cephalosporin

Cited by 141 publications

References 17 publications

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

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