Cephalosporins allergy cross-reactions

Because of cross-reactions between cephalosporins and penicillins, caution should be used when prescribing cephalosporins to patients with penicillin allergy. If a patient had anaphylaxis, angioedema, or urticaria fol-... 

Assem ESK, Vickers MR (1974) Tests for penicillin allergy in man. II. The immunological cross-reaction between penicillins and cephalosporins. Immunology 27 255 Assem ESK, Vickers MR (1975) Investigation of the response to some haptenic determinants in penicillin allergy by skin and in vitro allergy tests. Clin Allergy 5 43... 

Batchelor FR, Dewdney JM, Weston RD, Wheeler AW (1966) The immunogenicity of cephalosporin derivatives and their cross reaction with penicillin. Immunology 10 21 Batchelor FR, Dewdney JM, Feinberg JG, Weston RD (1967) A penicilloylated protein impurity as a source of allergy to benzyl penicillin and 6-aminopenicillanic acid. Lancet 1 1175... 

Some types of allergic reaction, for example immediate or delayed-type skin allergies, serum-sickness-like reactions and anaphylactic reactions, may occur in a proportion of patients given penicillin treatment. There is some, but not complete, cross-allergy with cephalosporins. 

Cephalosporins are sensitizing and may elicit a variety of hypersensitivity reactions that are identical to those of penicillins, including anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, and hemolytic anemia. However, the chemical nucleus of cephalosporins is sufficiently different from that of penicillins so that some individuals with a history of penicillin allergy may tolerate cephalosporins. The frequency of cross-allergenicity between the two groups of drugs is uncertain but is probably around 5-10%. However, patients with a history of anaphylaxis to penicillins should not receive cephalosporins. 

Allergic manifestations The cephalosporins should be avoided or used with caution in individuals allergic to penicillins (about 5 to 15% show cross-sensitivity). In contrast, the incidence of allergic reactions to cephalosporins is 1-2% in patients without a history of allergy to penicillins. 

The cephalosporins are contraindicated in patients with known allergies or intolerances to any of the cephalosporins. Because the penicillins and cephalosporins have a common chemical structure, cross-allergies occur with these drugs. Thus before initiating therapy with a cephalosporin, careful inquiry should be made concerning previous hypersensitivity reactions to the other drugs. Because a secondary vitamin K deficiency can develop with cephalosporin use, the cephalosporins are contraindicated in patients with hemophilia. Cefaclor is also contraindicated in any patient with previous drug-related joint and skin reactions. 

There is cross-allergy between all the various forms of penicillin, probably due in part to their common structure, and in part to the degradation products common to them all. Partial cross-allergy exists between penicillins and cephalosporins (a maximum of 10%) which is of particular concern when the reaction to either group of antimicrobials has been angioedema or anaphylactic shock. Carba-penems (meropenem and imipenem-cilastatin) and the monobactam aztreonam apparently have a much lower risk of cross-reactivity. 

Allergy Cephalosporins cause a range of allergic reactions from skin rashes to anaphylactic shock. These reactions occur less frequently with cephalosporins than with penicillins. Complete cross-hypersensitivity between different cephalosporins should be assumed. Cross-reactivity between penicillins and cephalosporins is incomplete (5-10%), so penicillin-allergic patients are sometimes treated successfully with a cephalosporin. However, patients with a history of anaphylaxis to penicillins should not be treated with a cephalosporin. 

Allergenicity is less commonly experienced and is less severe with cephalosporins than with penicillins. Cephalosporins frequently are administered to patients who have had a mild or delayed penicillin reaction. Cross-allergenicity is comparatively common, however, and cephalosporins should be administered with caution for patients who have a history of allergies. Patients who have had a rapid and severe reaction to penicillins should not be treated with cephalosporins. 

A retrospective review of all total hip and knee arthroplasties completed from 2007 to 2010 at a Canadian university hospital evaluated the cross-reactivity of cefazolin in patients who experienced a history of a non-IgE-mediated reaction to penicillin. The prevalence of penicillin allergy was 9.9%, and subsequent administration of cefazolin in these patients produced zero adverse reactions. This report adds to the evidence that penicillin/cephalosporin crossreactivity is generally overestimated [53 , 54 ]. 

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