Cross-Reactivity and Tolerability Of Cephalosporins In Patients With Ige-Mediated Hypersensitivity To Penicillins

Publication date: Available online 3 February 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Antonino Romano, Rocco Luigi Valluzzi, Cristiano Caruso, Michela Maggioletti, Donato Quaratino, Francesco Gaeta
BackgroundStudies performed since 1990 on samples of at least 30 subjects with a documented IgE-mediated hypersensitivity to penicillins have found a rate of positive responses to allergy tests with cephalosporins ranging from 0% to 27%.ObjectiveWe sought to assess the cross-reactivity with cephalosporins and evaluate the possibility of using cephalosporins in penicillin-allergic subjects.MethodWe conducted a prospective study of 252 consecutive subjects who had suffered 319 immediate reactions (mostly anaphylaxis) to penicillins and had positive skin tests to at least one penicillin reagent.All patients underwent serum specific IgE assays for cefaclor, as well as skin tests with 3 aminocephalosporins (cephalexin, cefaclor, and cefadroxil), cefamandole, cefuroxime, ceftazidime, ceftriaxone, cefotaxime, and cefepime. Patients with negative results for the last 5 cephalosporins were challenged with cefuroxime axetil and ceftriaxone; those with negative results for aminocephalosporins were also challenged with cefaclor and cefadroxil.ResultsNinety-nine participants (39.3%) had positive allergy tests for cephalosporins. Specifically, 95 (37.7%) were positive to aminocephalosporins and/or cefamandole, which share similar or identical side chains with penicillins.All 244 subjects who underwent challenges with cefuroxime axetil and ceftriaxone tolerated them. Of the 170 patients who underwent aminocephalosporin challenges, 3 reacted to cefaclor and 4 to cefadroxil.ConclusionsCross-reactivity between penicillins and cephalosporins seems to be mainly related to side chain similarity or identity.Subjects with an IgE-mediated hypersensitivity to penicillins could be treated with cephalosporins like cefuroxime and ceftriaxone that have side chain determinants different from those of penicillins and are negative in pretreatment skin testing.