Cross-allergy cephalosporins

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. 

Because penicillins and cephalosporins have a common chemical structure, cross-allergies occur with these drugs. Thus before initiating therapy with a penicillin. 

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. 

Immune cross-reactivity of benzylpenicillin and ceph-alothin was reported.23 cross-allergenicity to penicillins and cephalorsporins was noted.23 in contrast, in a study on the allergenicity and toxicity of cephaloridlne and ceph-alothin, no cross-allergy with the penicillins was observed.27 An orally effective cephalosporin, e.. cephalexin, as well as oral penicillins, would appear to have greatly less sensitizing potential than those given by injection. 

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-... 

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. 

It has also been reported that patients with allergic-like events after penicillin treatment have had a markedly risk of events after subsequent cephalosporin antibiotics. Cross-reactivity is not an adequate explanation for this increased risk and the data obtained indicate that cephalosporins can be considered for patients with penicillin allergy <2006MI354.ell>. Comparisons of parenteral broad-spectrum cephalosporins have been tested against bacteria isolated from pediatric patients. The results have indicated that cefepime has been the most broad-spectrum cephalosporin analyzed and it is a very potent alternative for the treatment of contemporary pediatric infections in North America <2007MI109>. The historical safety of the most commonly used oral cephalosporins has been reviewed <2007MIS67>. The antimicrobial spectrum and in vitro potency of the most frequently prescribed orally administered cephalosporins (cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil and cephalexin has also been reviewed <2007MIS5>. 

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. 

Ceftriaxone is a cephalosporin antibiotic. Consider using a different antibiotic if the person has a true penicillin allergy, as cephalosporins show cross-reactivity to penicillins in about 8% of people. 

Blanca M, Fernandez J, Miranda A, Terrados S, Torres MJ, Vega JM, Avila MJ, Perez E, Garcia JJ, Suau R. Cross-reactivity between penicillins and cephalosporins clinical and immnnologic stndies. J Allergy Clin Immunol 1989 83(2 Pt l) 381-5. 

Cross-reactivity between pencillins and cephalosporins ranges from 5% to 10%. Even though some patients with a history of penicillin allergy may tolerate cephalosporins, patients with a history of anaphylaxis to penicillin should not receive cephalosporins. 

Baldo BA. Penicilhns and cephalosporins as allergens Structural aspects of recognihon and cross-reachons. Clin Exp Allergy 1999 29 744-749. 

Once an individual is alleigjic to one penicillin, he or she is most likely allergic to all of the penicillins. Those alleigic to penicillin also have a higher incidence of allei to the cephalosporins (see Ch ). 8). Allergy to dni in the same or related groups is called cross-sensitivity or cross-allergenicity. 

First-generation cephalosporin prototype bactericidal beta-lactam inhibitor of cell wall synthesis. Active against gram-positive cocci, E coli, K pneumoniae. but does not enter CSF. Tox potential allergy partial cross-reactivity with penicillins. 

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. 

Cross-reactivities between antibodies to cephalosporins and penicillins have been observed in experimental animals (Brandriss et al. 1965 Batchelor et al. 1966 Gralnick and McGinnis 1967 Tadokoro et al. 1976) and in man (Abraham et al. 1968 b Grieco 1967 Stemberger et al. 1971 Delafuente et al. 1979). Among 701 patients with a history of penicillin allergy, 57 (8.1%) experienced an... 

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... 

Romano A, Gaeta F, Valluzzi RL, et al. IgE-mediated hypersensitivity to cephalosporins cross-reactivity and tolerability of penicillins, monobactams, and car-bapenems. 1 Allergy Clin Immunol. 2010 126 994-9. 

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