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1: J Allergy Clin Immunol. 2006 Feb;117(2):404-10.Click here to read Links

Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins.

Antunez C, Blanca-Lopez N, Torres MJ, Mayorga C, Perez-Inestrosa E, Montañez MI, Fernandez T, Blanca M.

Research Laboratory for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain.

BACKGROUND: Allergy to cephalosporins has mainly been evaluated in the context of patients with confirmed penicillin allergy. The problem of studying cross-reactivity in subjects primarily sensitized to cephalosporins and potentially allergic to penicillins has not been sufficiently addressed. OBJECTIVE: To evaluate the in vitro IgE response and cross-reactivity to betalactams in patients with immediate allergic reactions to cephalosporins. METHODS: The study included 24 patients with immediate allergic reactions to cephalosporins and RAST-positive to at least 1 cephalosporin. Skin testing and RAST were performed with a panel of penicillins and cephalosporins. RAST inhibition assay with different monomeric conjugates of penicillin and cephalosporin was performed to establish cross-reactivity. RESULTS: The culprit cephalosporins were cefaclor (N = 7), cefonicid (N = 1), cefotaxime (N = 2), ceftazidime (N = 2), ceftriaxone (N = 3), and cefuroxime (N = 9). Two patients had a positive skin test result to penicillin determinants, and 22 patients had a negative result to penicillin determinants and tolerated benzylpenicillin administration. Of these 22, 19 had a positive skin test result to cephalosporins and divided into patients reacting only to the culprit cephalosporin (63.2%) and those reacting to more than 1 cephalosporin (36.8%). RAST and RAST inhibition studies confirmed that the side chain at the R1 position is crucial for recognition. CONCLUSION: The R1 side chain rather than the betalactam structure, shared by penicillins and cephalosporins, seems to play a dominant role in determining the specificity of immunologic reactions to cephalosporins. Thus, penicillin can be administered safely to patients allergic to cephalosporins and with a negative skin test result to penicillin determinants.

PMID: 16461141 [PubMed - indexed for MEDLINE]

Patient Drug Information

  • Cefuroxime (Ceftin® , Zinacef® )

    Cefuroxime is used to treat certain infections caused by bacteria, such as bronchitis; gonorrhea; Lyme disease; and infections of the ears, throat, sinuses, urinary tract, and skin. Cefuroxime is in a class of medication...

  • Cefaclor (Ceclor® , Ceclor® Pulvules® )

    Cefaclor is used to treat certain infections caused by bacteria, such as pneumonia and infections of the ears, lungs, throat, urinary tract, and skin. Cefaclor is in a class of medications called cephalosporin antibiotic...

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