Beta-Lactam Hypersensitivity and Cross-Reactivity

Abstract

Penicillin is the most frequently reported cause of drug allergy, and cross-reactivity of penicillins with other beta-lactam antibiotics is an area of debate. This review evaluates the available data on immunoglobulin E-mediated penicillin hypersensitivity and cross-reactivity with cephalosporin, carbapenem, and monobactam antibiotics. A MEDLINE search was conducted from 1950 to October 2013, and selected references from review articles were also evaluated. There is a wide variety in reported incidences of cross-reactivity between penicillins and cephalosporins or carbapenems, with early retrospective studies suggesting up to 41.7% and 47.4% cross-reactivity, respectively. Conversely, the use of monobactam antibiotics is frequently employed in the case of a penicillin allergy, as prescribers believe that there is no cross-reactivity between the 2 drug classes. More recent prospective studies suggest that the rates of cross-reactivity with cephalosporins and carbapenems are <5% and <1%, respectively. Similarities in penicillin and cephalosporin side chains may play a role in cross-reactivity between these classes. Cross-reactivity with monobactams is essentially negligible; however, there are some clinical data to support an interaction between ceftazidime and aztreonam, due to the similarity of their side chains. The data reviewed suggest that avoidance of other beta-lactams in patients with type 1 hypersensitivity to penicillins should be reconsidered.

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

“…However, as many as 27 different empiric antibiotic combinations were selected for high‐risk FN in the setting of beta‐lactam allergy. Notably, a cephalosporin‐containing regimen was selected by 11% for beta‐lactam anaphylaxis despite the potential for 5% cross‐reactivity with these agents . Antibiotic allergy in the adult cancer population is associated with increased antibiotic duration, inappropriate prescribing and higher readmission rates, suggesting that guidelines should address allergy recommendations, and antibiotic allergy de‐labelling strategies are employed …”

“…Notably, a cephalosporin-containing regimen was selected by 11% for beta-lactam anaphylaxis despite the potential for 5% cross-reactivity with these agents. 17 Antibiotic allergy in the adult cancer population is associated with increased antibiotic duration, inappropriate prescribing and higher readmission rates, suggesting that guidelines should address allergy recommendations, and antibiotic allergy de-labelling strategies are employed. 18 The majority of respondents appropriately identified severe sepsis as an important factor in guiding decisions to use aminoglycoside-containing dual therapy.…”

Anaphylactic shock caused by intramuscular injection of midazolam during the perioperative period: a case report

“…Cross-reactivity between benzodiazepines is a part that should not be overlooked. Cross-reactivity between neuromuscular blocking agents and antibiotics is known to be common due to structural similarity in these drugs [ 4 5 14 ]. In case of neuromuscular blocking agents, cross-reactivity occurs in up to 60% of the patients [ 4 5 ].…”

Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients

“…In orthopaedic surgery the first choice antibiotics for prophylaxis are cephalosporins, especially cefazolin [17,18]. IgE-mediated hypersensitivity reactions have been reported with the use of cephalosporins, as a cross-reaction between different cephalosporins or as a cross-reaction to other b-lactam antibiotics, namely, penicillin [19][20][21]. Allergic reaction is as a form of hypersensitivity, formally known as Type 1 hypersensitivity, and although distinctive, results in inflammation.…”