Cephalosporins allergy determinants

An accurate molecular definition of cephalosporin allergy is not currently available. Relevant determinants of cephalosporin-induced anaphylaxis may not reside in the bicyclic core, but rather in the side chain (164,165). 

Bundgaard H (1974) Spectrophotometric determination of ampicillin sodium in the presence of its degradation and polymerization products. J Pharm Pharmacol 26 385 Bundgaard H (1975) Chemical studies related to cephalosporin allergy. I. Kinetics of aminolysis of cephalosporins and effect of C-3 substituents on beta-lactam reactivity. Arch Pharm 3 94... 

Penicillins and cephalosporins bind irreversibly to serum albumin. It has been shown that drug-protein conjugates result from the aminolysis of the /3-lactam bond by the e-amino group of lysine residues in the protein (Fig. 5.1, Pathway e). The bound penicilloyl group appears to be the major antigenic determinant of penicillin allergy [145-148],... 

Ong R, Snlhvan T. Detection and characterization of human IgE to cephalosporin determinants. J Allergy Clin Immunol 1988 81 222. 

Before administering cephalosporins, assess for allergies, vital signs, and urine output. Check laboratory results, especially those that indicate renal and liver function such as BUN, serum creatinine, AST, ALT, ALP, and bilimbin. Also monitor bleeding time (PT and PTT) and white blood cell count. Obtain a tissue or blood specimen for a culture and sensitivity if possible to determine if cephalosporins are the right antibiotic. 

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... 

Studies on the chemical aspects of penicillin allergy have shown that the penicilloyl determinant in penicillin allergy can be formed by the reaction of benzylpenicillenic acid with free functional groups in proteins, Benzylpenicillenic acid can react with SH groups of protein to form thio-esters similar to its reaction with amino groups to form amides a. Products obtained in aminolysis and enzymic hydrolysis of cephalosporins... 

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