Immediate allergic reactions to cephalosporins and penicillins and their cross‐reactivity in children

Atanasković-Marković, Marina; Veličković, Tanja Ćirković; Gavrović-Jankulović, Marija; Vučković, Olga; Nestorovic, Branimir

doi:10.1111/j.1399-3038.2005.00280.x

Cited by 95 publications

(63 citation statements)

References 39 publications

(65 reference statements)

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“…In another study including ten patients with confirmed IgE-mediated allergy to cefazolin, cross-reactivity with penicillin was only detected in 10 % of cases [51]. In children, similar figures of cross-reactivity have been found, ranging from 0.3 to 23.9 %, with the figure being higher for earlier generation cephalosporins [53].…”

Section: Penicillin As An Alternative Treatmentsupporting

confidence: 54%

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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Section: Penicillin As An Alternative Treatmentsupporting

confidence: 54%

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

View full text Add to dashboard Cite

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“…163 For penicillin-allergic children, recent data suggest that cross-reactivity among penicillins and cephalosporins is lower than historically reported. [164][165][166][167] The previously cited rate of cross-sensitivity to cephalosporins among penicillin-allergic patients (approximately 10%) is likely an overestimate. The rate was based on data collected and reviewed during the 1960s and 1970s.…”

Section: Microbiologymentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

1,062

832

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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“…7 More recent studies have demonstrated cross-reactivity rates as low as 1%. 8 The common beta-lactam ring is the putative reason for potential cross-reactivity between penicillins and cephalosporins.…”

Section: Beta-lactam Ringmentioning

confidence: 99%

Cephalosporin allergy label is misleading

Yuson¹,

Katelaris²,

Smith³

2018

Aust Prescr

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SUMMARYPenicillins and cephalosporins can cause a similar spectrum of allergic reactions at a similar rate.Cross-reactive allergy between penicillins and cephalosporins is rare, as is cross-reaction within the cephalosporin group. Patients should therefore not be labelled 'cephalosporin-allergic'.Cross-reactive allergy may occur between cephalosporins (and penicillins) which share similar side chains.Generally, a history of a penicillin allergy should not rule out the use of cephalosporins, and a history of a specific cephalosporin allergy should not rule out the use of other cephalosporins.Specialist advice or further investigations may be required when the index reaction was anaphylaxis or a severe cutaneous adverse reaction, or when the antibiotics in question share common side chains.When recording a drug allergy in the patient's records, it is important to identify the specific drug suspected (or confirmed), along with the date and nature of the adverse reaction. Records need to be updated after a negative drug challenge. 'Cephalosporin allergy' label is misleadingas Stevens-Johnson syndrome, toxic epidermal necrolysis or acute generalised exanthematous pustulosis or organ hypersensitivity). Structural chemistry and allergyImmunological reactivity to small molecules such as antibiotics depends on the formation of haptens. These are stable covalent complexes of the drug with larger carrier molecules such as serum or membrane proteins. For penicillin, this occurs when the betalactam ring spontaneously opens to form penicilloyl which binds to lysine residues on host proteins. Beta-lactam ringCephalosporins and penicillins share the four-atom beta-lactam ring structure. In penicillins the betalactam ring is linked to a five-member thiazolidine ring whereas in cephalosporins it is linked to the dihydrothiazine ring (see Figs 1 and 2).It was previously thought that people allergic to penicillins had a high likelihood of allergy to any cephalosporins (reportedly up to 23.9%).7 More recent studies have demonstrated cross-reactivity rates as low as 1%. 8The common beta-lactam ring is the putative reason for potential cross-reactivity between penicillins and cephalosporins. However, there is in fact little theoretical basis for this. Penicillins are chemically reactive due to a high degree of tension between the beta-lactam ring and the thiazolidine ring, whereas the cephalosporin beta-lactam ring forms a more IntroductionTo label an individual with a 'cephalosporin allergy' is misleading. Given the structural diversity of the cephalosporin family, hypersensitivity is seldom a class effect but is much more likely to relate to the individual drug. Cross-reactivity within the family is very limited and is more likely to relate to the side chain than the core structure.1 A greater awareness of this in clinical practice would lead to the availability of alternative cephalosporins and prevent unnecessary use of other classes of broad-spectrum antibiotics.Cephalosporins were first introduced in the 1960s, 2 and are one of...

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Immediate allergic reactions to cephalosporins and penicillins and their cross‐reactivity in children

Cited by 95 publications

References 39 publications

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

The Diagnosis and Management of Acute Otitis Media

Cephalosporin allergy label is misleading

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