Food, drug, insect sting allergy, and anaphylaxisIgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of penicillins, monobactams, and carbapenems
Section snippets
Patient selection
Subjects were recruited from a large outpatient population with a history of immediate reactions to at least 1 cephalosporin. To be included in the study, a subject must have experienced a positive skin test result to the responsible cephalosporin. An indication for treatment with β-lactams other than cephalosporins was not a criterion of inclusion. We used skin tests to evaluate sensitization to aztreonam and carbapenems (imipenem/cilastatin and meropenem). In the event of negative results to
Results
We examined 98 subjects (68 female and 30 male subjects) who ranged in age from 13 to 90 years (mean age, 44.5 ± 21 years) and had a well-demonstrated, IgE-mediated hypersensitivity to cephalosporins. These subjects constituted 71% of an outpatient population of 138 adults recruited prospectively between January 2000 and December 2008 in the Allergy Units of C.I. Columbus and Oasi Maria S.S. because they had a history of immediate reactions to cephalosporins. None of the 98 subjects had a
Discussion
IgE-mediated reactions to cephalosporins occur because of sensitization to determinants shared with other β-lactams or to unique cephalosporin haptens.32, 33, 34 Therefore in subjects with hypersensitivity reactions to cephalosporins, physicians should use responsible cephalosporins in allergologic tests in addition to the classic penicillin reagents.8, 29, 35 The rate of positive responses to the penicillin reagents observed in the present study (25.5% [25/98] of subjects) falls within the
References (41)
- et al.
Variation in antibiotic use in the European Union
Lancet
(2001) - et al.
Cephalosporin allergy
Immunol Allergy Clin North Am
(2004) - et al.
Immediate allergic reactions to cephalosporins: evaluation of cross-reactivity with a panel of penicillins and cephalosporins
J Allergy Clin Immunol
(2006) Sensitization to aztreonam and cross-reactivity with other beta-lactam antibiotics in high-risk patients with cystic fibrosis
J Allergy Clin Immunol
(1991)- et al.
Tolerability of imipenem in children with IgE-mediated hypersensitivity to penicillins
J Allergy Clin Immunol
(2009) - et al.
Diagnosis of penicillin, amoxicillin, and cephalosporin allergy: Reliability of examination assessed by skin testing and oral challenge
J Pediatr
(1998) - et al.
Immediate allergic reactions to cephalosporins: cross-reactivity and selective responses
J Allergy Clin Immunol
(2000) - et al.
A case of IgE-mediated hypersensitivity to ceftriaxone
J Allergy Clin Immunol
(1999) - et al.
Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium
J Allergy Clin Immunol
(2006) - et al.
Non-specific cross-reactivity of hydrophobic serum IgE to hydrophobic drugs
Mol Immunol
(1995)
Cross-reactivity between a penicillin and a cephalosporin with the same side chain
J Allergy Clin Immunol
Aztreonam-induced anaphylaxis
Lancet
Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000
Emerg Infect Dis
European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe
J Antimicrob Chemother
Immediate hypersensitivity reactions to beta-lactam antibiotics
Ann Intern Med
Cephalosporin allergy
N Engl J Med
Immediate hypersensitivity to cephalosporins
Allergy
Diagnosis of immediate allergic reactions to beta-lactam antibiotics
Allergy
Diagnosing immediate reactions to cephalosporins
Clin Exp Allergy
IgE-mediated hypersensitivity to cephalosporins
Curr Pharm Des
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Supported by MURST (Italian Ministry for University, Scientific and Technological Research).
Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.