Diagnosing nonimmediate reactions to cephalosporins

Romano, Antonino; Gaeta, Francesco; Valluzzi, Rocco Luigi; Caruso, Cristiano; Alonzi, Cristiana; Viola, Marinella; Bousquet, Philippe‐Jean

doi:10.1016/j.jaci.2011.12.995

Cited by 85 publications

(45 citation statements)

References 10 publications

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“…In the present study, in effect, delayed-reading intradermal tests have proved to be more sensitive than skin prick tests and patch tests, as observed in previous studies, which assessed subjects with nonimmediate reactions to b-lactams, especially cephalosporins. 24,31,35 All this might explain the fact that we observed only 1 subject with a positive challenge response to cefaclor among the 213 participants who underwent a total of 935 challenges with cephalosporins found to elicit negative responses in the allergy workup.…”

Section: Discussionmentioning

confidence: 94%

“…26 The concentrations used for cephalosporins proved to be nonirritating in previous studies. [26][27][28][29][30][31][32] We also administered patch tests with cephalexin, cefaclor, and cefadroxil at 5% in petrolatum (F.I.R.M.A. ).…”

Section: Skin and Patch Testsmentioning

confidence: 99%

“…In cases with negative responses, 1 week later, we administered a dose of one tenth and, if the responses were again negative, after another week a full dose, as previously described. 4,31,34 After the first 30 challenges with each b-lactams, we modified this workup, administering an initial dose of one tenth of the therapeutic dose, and if the response was negative, we administered a full dose 1 week later. After 30 additional challenges, we administered an initial dose of one tenth of the therapeutic dose, and, if the response was negative, we administered a full dose 1 hour later.…”

Section: Skin and Patch Testsmentioning

confidence: 99%

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Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell–mediated hypersensitivity to penicillins

Romano

Gaeta²,

Valluzzi³

et al. 2016

Journal of Allergy and Clinical Immunology

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These data demonstrate a rate of cross-reactivity between aminopenicillins and aminocephalosporins (ie, cephalexin, cefaclor, and cefadroxil) of around 20%, as well as the absence of cross-reactivity between penicillins and cefuroxime, ceftriaxone, and aztreonam in all subjects with T cell-mediated hypersensitivity to penicillins, almost exclusively aminopenicillins. Therefore these subjects could be treated with cefuroxime, ceftriaxone, and aztreonam. In those who especially require cephalosporin or aztreonam treatment, however, we recommend pretreatment skin tests because negative responses indicate tolerability.

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Section: Discussionmentioning

confidence: 94%

Section: Skin and Patch Testsmentioning

confidence: 99%

Section: Skin and Patch Testsmentioning

confidence: 99%

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Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell–mediated hypersensitivity to penicillins

Romano

Gaeta²,

Valluzzi³

et al. 2016

Journal of Allergy and Clinical Immunology

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“…In two patients, cephalexin displayed skin test cross-reactivity with aminopenicillins likely due to a shared side chain amino group. The index cephalosporin was tolerated by all 86 patients with negative skin tests who agreed to challenge [204].…”

Section: Cross-reactivity Between Cephalosporins and Penicillinsmentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

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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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“…However, for nonimmediate reactions, challenge tests are much more problematic. In particular, it is not clear for how long one should challenge, such as 1, 3, or 7 days or with weekly incremental single doses, as in the study by Romano et al 2 One should keep in mind that a diagnosis is a means for optimal further management and not an end in itself. Avoiding further use of the incriminated drug without performing a challenge test might be a pragmatic and widely used approach, especially if the incriminated drug is easy to replace.…”

mentioning

confidence: 99%