Penicillin allergenicity

Heterogeneity of IgE Antibody Responses to Penicillins and the Spectrum of Penicillin Allergenic Determinants... 

Harle DG, Baldo BA. Identification of penicillin allergenic determinants that bind IgE antibodies in the sera of subjects with penicillin allergy. Mol Immunol. 1990 27 1063-71. 

Anaphylactic Allergen binds to IgE on baso- Within 30 Penicillin immediate... 

Facilities for the manufacture of penicillins are frequently dedicated so that other drugs will not be contaminated with even small amounts of these potential allergens. 

Cross-allergenicity with cephalosporins Individuals with a history of penicillin hypersensitivity have experienced severe reactions when treated with a cephalosporin. The incidence of cross-allergenicity between penicillins and cephalosporins is estimated to range from 5% to 16% however, it is possible the incidence is much lower, possibly 3% to 7%. 

Cross-allergenicity with penicillin Administer cautiously to penicillin-sensitive patients. There is evidence of partial cross-allergenicity cephalosporins cannot be assumed to be an absolutely safe alternative to penicillin in the penicillin-allergic patient. The estimated incidence of cross-sensitivity is 5% to 16% however, it is possibly as low as 3% to 7%. 

Hypersensitivity reactions Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with beta-lactams. These reactions are more likely to occur in individuals with a history of sensitivity to multiple allergens. There have been reports of individuals with a history of penicillin P.903... 

Cephalosporins Cross-allergenicity Contraindicated in patients with history of anaphylaxis to penicillins Disulfiram-like reaction with ethanol... 

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. 

Aztreonam Prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases Rapid bactericidal activity against susceptible bacteria Infections caused by aerobic, gram-negative bacteria in patients with immediate hypersensitivity to penicillins IV administration renal clearance half-life 1.5 h dosed every 8 h Toxicity No cross-allergenicity with penicillins... 

A serious threat to health, also in persons who are not hypersensitive to allergens, is created by antibiotics present in food products. It has been confirmed that penicillin in particular as well as other antibiotics of the group of P-lactams (penicillins,... 

An estimated 1-17% of the population of the United States is considered at risk for having an anaphylactic reaction if exposed to one or more allergens, especially penicillin and insect stings. Most affected individuals successfully avoid such allergens and will never experience anaphylaxis. Of those who actually experience anaphylaxis, up to 1% may die as a result. Anaphylaxis results in approximately 18 deaths per year in the USA (compared to 2.4 million deaths from all other causes each year). The most common presentation includes sudden cardiovascular collapse (88% of reported cases of severe anaphylaxis). 

Aztreonam - intramuscular or intravenous - is excreted unchanged by glomerular filtration and renal tubular secretion. It lacks the allergenic tricyclic nuclear structure of penicillins, cephalosporins and carbapenem beta-lactams. 

Clavulanic acid has a very low immunogenic and allergenic potential in animals. The possible impact of its co-administration with other beta-lactam antibiotics is unknown (53). Two patients with IgE-mediated hypersensitivity to oral co-amoxiclav and positive skin tests for clavulanic acid, but not for penicillins, both tolerated oral amoxicillin. One patient was also challenged with clavulanic acid and developed urticaria, conjunctivitis, and bronchial obstruction (54). Since co-amoxiclav has been widely used since its introduction in 1981, the frequency of hypersensitivity reactions is low. The clinical data available on sulbactam and tazobactam are stiU hm-ited and do not allow an assessment of the frequency and pattern of associated hypersensitivity reactions (55). 

Like penicillins, cephalosporins are a relatively nontoxic group of antibiotics. The primary adverse effect reported is hypersensitivity, a rare event. Cross-allergenicity with penicillins may occur. Toxicity is unlikely in children less than 6 years of age who acutely ingest less than 250 mg kg Nephrotoxicity is a possible, but rare, occurrence with acute ingestion. Coagulopathies have been reported following chronic intravenous use of certain cephalosporins. At higher... 

---