Urticaria and Anaphylaxis due to Betalactams (Penicillins and Cephalosporins)

Torres, Marı́a José; Mayorga, Cristobalina; Blanca, Miguel

doi:10.1159/000104200

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…A previous study reported that 38% of patients with a selective response to AX developed cross-reactivity to cefadroxil with identical side chains [23]. The presence of identical side chains contributes to high cross-reactivity between penicillin and cephalosporins, implying that a patient who is allergic to a β-lactam antibiotic can better tolerate another β-lactam antibiotic with dissimilar side chains than one with identical side chains [23, 24]. …”

Section: Introductionmentioning

confidence: 99%

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Şimşek

Çöğürlü

Aydoğan³

2018

Int Arch Allergy Immunol

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Background: Most children diagnosed with β-lactam allergy based only on history are not truly allergic, and mislabeling leads to use of less effective and more costly alternative broader-spectrum antibiotics, significantly increasing drug resistance. Objective: To determine the frequency and risk factors of confirmed allergy in patients with β-lactam allergy reported by parents or their doctors and evaluate cross-reactivity between β-lactams in children with confirmed allergy. Method: Sixty-seven children with suspected β-lactam allergy were evaluated via history, sIgE measurements, skin tests, and drug provocation tests over a period of 5 years. Results: β-Lactam allergy was confirmed in 10 (14.9%) patients. Six patients had a positive intradermal test result to one or more of the penicillin skin test materials or ceftriaxone, 4 patients with negative skin test results had positive test results with suspected drugs. Age, gender, time interval between evaluation and the initial reaction, personal history of atopy, parental history of drug allergy, reaction type, and multiple drug allergy history were not significantly different between allergic and tolerant patients. For culprit drugs, there was a significant different between the 2 groups; the rate of confirmed diagnosis was significantly higher for cephalosporins such as ceftriaxone, cefuroxime, and cefprozil (p = 0.03). Three patients with allergy to penicillin tolerated cefuroxime; in 4 patients with selective allergy to ceftriaxone tolerated cephalosporins with a dissimilar side chain (cefadroxil, cefuroxime, cefaclor, and cefdinir). Conclusion: Our study indicates that most patients with a suspected β-lactam allergy tolerated this drug. An appropriate diagnostic allergy workup may prevent the use of less effective and more expensive alternatives.

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Section: Introductionmentioning

confidence: 99%

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Şimşek

Çöğürlü

Aydoğan³

2018

Int Arch Allergy Immunol

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“…For penicillin, this occurs when the betalactam ring spontaneously opens to form penicilloyl which binds to lysine residues on host proteins. 6 …”

Section: Structural Chemistry and Allergymentioning

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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“…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. 16 In another study on selective amoxicillin hypersensitivity, Miranda et al 23 have shown that oral challenge with cephadroxil, a firstgeneration cephalosporin that shared the same sidechain mentioned above, resulted in a cross-reactivity of 38%. On the other hand, use of cefamandole, a second-generation cephalosporin with a different side-chain from amoxicillin and cephadroxil, did not result in any cross-reactivity.…”

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

confidence: 99%

“…Immediate hypersensitivity is the result of crosslinking of adjacent surface IgE molecules by the hapten-protein conjugates that culminates in rapid degranulation of preformed inflammatory mediators such as histamine and tryptase. 16 …”

Section: Mechanism Of Beta-lactam Hypersensitivitymentioning

confidence: 99%

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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Urticaria and Anaphylaxis due to Betalactams (Penicillins and Cephalosporins)

Cited by 6 publications

References 29 publications

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Suspected Reaction with Cephalosporin May Be a Predictive Factor for β-Lactam Allergy in Children

Cephalosporin allergy label is misleading

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

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