Penicillins allergy hypersensitivity

C. W. Parker, J. Shapiro, M. Kern, H. N. Eisen, Hypersensitivity to Penicillenic Acid Derivatives in Human Beings with Penicillin Allergy , J. Exp. Med. 1962, 115, 821-838. 

Cefazolin penetrates well into most tissues. It is a drug of choice for surgical prophylaxis. Cefazolin may be a choice in infections for which it is the least toxic drug (eg, penicillinase-producing E coli or pneumoniae) and in persons with staphylococcal or streptococcal infections who have a history of penicillin allergy other than immediate hypersensitivity. Cefazolin does not penetrate the central nervous system and cannot be used to treat meningitis. Cefazolin is an alternative to an antistaphylococcal penicillin for patients who are allergic to penicillin. 

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. 

Establish the nature of the patient s penicillin allergy and if a history of type 1 hypersensitivity is suspected, suggest an alternative regimen to the clinician to incorporate MRSA cover such as vancomycin plus ciprofloxacin plus metronidazole. Do not delay treatment to allow time for a deep tissue specimen to be taken. 

Negligible cross-reactivity has been reported in both animal and human studies involving hapten inhibition, skin tests, and treatment of penicillin-allergic patients with therapeutic doses of aztreonam (12,14-19). Aztreonam therefore seems to be a safe alternative for patients with penicillin allergy. However, the numbers of safely treated patients reported are still small, and immediate type hypersensitivity to aztreonam has been reported in patients with penicillin allergy (20-23). 

One of the most helpful tests to evaluate risk of penicillin allergy is the skin test. Skin testing can demonstrate the presence of penicillin-specific IgE and predict a relatively high risk of immediate hypersensitivity reactions. Skin testing does not predict the risk of delayed or most dermatologic reactions. 

Parker CW, Kern M, Eisen HN (1962 b) Hypersensitivity to penicillenic acid derivatives in humans with penicillin allergy. J Exp Med 115 821 Parker D, Aoki T, Turk JL (1970) Studies on the ability of the soluble proteins from skin, painted in vivo with DNFB, to cause contact sensitivity in the guinea pig. Int Arch Allergy Appl Immunol 38 42-56... 

Dogliotti M (1975) Tests for penicillin allergy. Med Lett Drugs Ther 17 54 Dry J, Leynadier F, Damecour C, Pradalier A, Herman D (1976) Reaction pseudo-anaphy-lactique a la procaine-penicilline G. Nouv Presse Med 5 1401 Dudley KH, Butler TC, Johnson D (1971) Chemical studies of potential relevance to penicillin hypersensitivity the fate of benzylpenicillenic acid in aqueous buffer solutions. J Pharmacol Exp Ther 179 505... 

Kerr RO, Cardamone J, Dalmasso AP, Kaplan ME (1972) Two mechanisms of erythrocyte destruction in penicillin-induced hemolytic anemia. N Engl J Med 287 1322 Klein KG, Parkin JD, Madaras F (1976) Studies on an acquired inhibition of factor VIII induced by penicillin allergy. Clin Exp Immunol 26 155 Klemola E (1970) Hypersensitivity reactions to ampicillin in cytomegalovirus mononucleosis. Scand J Infect Dis 2 29... 

Atopu - The immunologic disorders caused by IgE antibodies, colloquially referred to as "allergies." Examples are hay fever, certain forms of asthma and drug hypersensitivities (e.g., "penicillin allergy"). 

A hypersensitivity (or allergic) reaction to a drug occurs in some individuals, especially those with a history of allergy to many substances. Signs and symptoms of a hypersensitivity to penicillin are highlighted in Display 7-3. 

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