Cephalosporins immunological reactions

Petz LD. Immunologic reactions of humans to cephalosporins. Postgrad Med J 1971 47(Suppl) 64-9. 

Most instance of drug-induced renal disease are probably due to direct toxicity. Even cephalosporins such as cephalothin or cephaloridin, which can produce immunological reactions, more frequently damage the kidney directly (Parker 1979 a). 

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... 

Petz LD (1971) Immunological reactions of humans to cephalosporins. Postgr Med J Feb Suppl 64... 

A third type of immune-mediated mechanism has occurred with cephalosporin derivatives. The cephalosporins can combine with nonspecific proteins, including albumin, IgG, IgA, and fibrinogen, and adhere to the RBC when this happens, a Coombs test will have apos-itive result. The binding is not immunologic in origin, and hemolytic anemia has not been associated with this reaction (Fig. 102-5). How-... 

The only drugs which in fact have been shown to be capable of reacting covalently with proteins in vitro and for which such conjugation reactions in vivo appear to be of marked immunologic significance are the jS-lactam antibiotics, penicillins and cephalosporins (for a recent review, see Dewdney 1977). 

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... 

Immunologic Of 85 patients with a history of penicillin allergy and positive penicillin skin tests 5 (6%) had an adverse drug reaction to a cephalosporin compared with 5 (0.7%) of 726 patients with a history of penicillin allergy but negative penidllin skin tests [7. Presumed IgE-mediated adverse reactions to the cephalosporins occurred in 2 (2%) of the former compared with only 1 (0.1%) of the latter. 

Immunologic Cefuroxime has been studied in 650 subjects, of whom 143 (22%) were sensitive to at least one beta-lactam other than cefuroxime, 118 to penicillins, 8 to cephalosporins, and 17 to both 9 were also sensitized to cefuroxime [27 ]. The prevalence of cefuroxime hypersensitivity reactions in the whole group was 6.3% and in those who were sensitive to penicillin 4.2%. 

Pseudoallergic reactions resemble allergic reactions clinically but are not immunologically mediated. Examples include asthma and rashes caused by aspirin and maculopapular erythematous rashes due to ampicillin or amoxicillin in the absence of penicillin hypersensitivity. Few other entities that can initiate this reaction are sulfonamides, anticonvulsants (phenytoin, carbamazepine and phenobarbital), NSAIDs (aspirin, naproxen, nabumetone and keto-profen), antiretroviral agents and cephalosporins [1 ]. 

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