Summary Statement 97: Since 1980, studies show that approximately 2% of penicillin skin test–positive patients react to treatment with cephalosporins, but some of these reactions may be anaphylactic reactions. Cephalosporin administration to patients with a history of penicillin allergy (D) Summary Statement 96: Cephalosporins and penicillins share a common beta-lactam ring structure and moderate crossreactivity has been documented in vitro. (D) Treatment with cephalosporins with dissimilar side chains may be considered, but the first dose should be given via graded challenge or induction of drug tolerance, depending on the severity of the previous reaction. (D) Summary Statement 95: Patients with a history of an immediate-type reaction to 1 cephalosporin should avoid cephalosporins with similar R-group side chains. (D) A negative skin test result does not rule out an allergy because the negative predictive value is unknown. (D) Summary Statement 94: Skin testing with native cephalosporins is not standardized, but a positive skin test result using a nonirritating concentration suggests the presence of drug specific IgE antibodies. (C) Summary Statement 93: Most hypersensitivity reactions to cephalosporins are probably directed at the R-group side chains rather than the core beta-lactam portion of the molecule. Summary Statement 92: The overall reaction rate to cephalosporins is approximately 10-fold lower than it is for penicillin. Summary Statement 71: Approximately 10% of patients report a history of penicillin allergy, but after complete evaluation, up to 90% of these individuals are able to tolerate penicillins. Some quotes from the 2010 Practice Parameter for Drug Allergy with evidence basis provided in parenthesis are: (Annè, Macy) Finally there is evidence of increased risk for any medication, irrespective of structure similarities or cross-reactivity, if there is history of prior drug reaction (Strom). (Romano Kelkar Mirakian) However, other analyses minimize risk. The medical literature suggests there is greater risk in giving cephalosporin, particularly first generation cephalosporin, to a patient with a history of penicillin allergy than to a patient without penicillin allergy (2-4 fold increased risk). All rights reserved.The difficulty in answering your question is the meaning of “safe” and the meaning of “penicillin allergic patient”. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.Īllergy Anaphylaxis Beta-lactam Cephalosporin Cross-reactivity Penicillin Skin test.Ĭopyright © 2019 American Academy of Allergy, Asthma & Immunology. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. 8 Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.Ĭephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients.7 Department of Internal Medicine, Cleveland Clinic, Respiratory Institute, Department of Allergy and Clinical Immunology, Cleveland, Ohio.6 Department of Internal Medicine, George Washington University Medical Center, Washington, DC.5 Department of Medicine, Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Mass.4 Department of Chemical and Biomedical Engineering, Notre Dame, Ind.3 Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.Electronic address: 2 Department of Medicine, Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, Mass. 1 Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
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