Food and drug reactions and anaphylaxis
Immediate allergic reactions to cephalosporins: Cross-reactivity and selective responses,☆☆

https://doi.org/10.1067/mai.2000.111147Get rights and content

Abstract

Background: After penicillins, cephalosporins are the most important β-lactams inducing IgE-mediated reactions. Responses may be selective or cross-reactive with common β-lactam determinants. Unlike determinants derived from benzylpenicillin, cephalosporin allergenic determinants have not been properly identified, even though a wide variety of these β-lactams is currently used. Objective: We sought to evaluate the IgE response in subjects with immediate allergic reactions to injectable cephalosporins and to assess their reactivity to different penicillins and cephalosporins. Methods: We studied 30 subjects with immediate reactions to one or more of the following cephalosporins: ceftriaxone, cefotaxime, ceftazidime, and cefuroxime. Skin tests and in vitro–specific IgE antibody assays were performed for major and minor determinants of penicillin G, amoxicillin, and ampicillin, as well as for the culprit cephalosporins. Responses to cephalosporins other than the culprit ones were also studied by using skin testing. Results: Twenty-six patients (group A, 86.7%) displayed skin test and RAST negativity to penicillin determinants and skin test positivity to cephalosporins, with RAST confirmation in 9 patients. Four subjects (group B, 13.3%) had a positive response to penicillin determinants. In group A two patterns of reactivity were observed: one characterized by a response only to the culprit cephalosporin (n = 15, 57.7%) and the other by positive responses to different cephalosporins, including the responsible cephalosporins (n = 11, 42.3%). Conclusion: Most patients with a history of immediate reactions to cephalosporins are sensitized to determinants generated only by cephalosporins (group A), although a small percentage react to penicillin determinants (group B). Some patients from group A responded only to the culprit cephalosporin, but others reacted to different cephalosporins. These findings can be explained in terms of either selective response to unique determinants or cross-reactivity. (J Allergy Clin Immunol 2000;106:1177-83.)

Section snippets

Patient selection

Subjects were selected from a large outpatient Italian population with a history of immediate reactions to injectable cephalosporins and positive results in allergologic evaluations performed between January 1995 and June 1998. We first evaluated the possible existence of allergy to penicillins by using skin tests and RASTs. Allergy to cephalosporin derivatives was evaluated by using skin tests to different cephalosporin compounds, including the culprit drug. In vitro–specific cephalosporin IgE

Results

A total of 30 patients (11 male and 19 female patients) were included in the study. The mean age was 40 years, ranging from 5 to 79 years. Our work-up was performed with a time interval of 12.36 ± 13.4 months (range, 1-48 months) after the most recent adverse reaction. Clinical data are shown in Table I. In all patients the time between drug administration and the onset of symptoms was less than 1 hour. The patients had a total of 25 episodes of anaphylactic shock and 11 episodes of urticaria

Discussion

Most studies of β-lactam allergy have been based on responses to penicillin or its derivatives.1, 2, 4 Furthermore, in studies of cross-reactivity between penicillins and cephalosporins, the subjects were originally sensitized to penicillins and cross-reactivity with cephalosporins was assessed by testing one or two compounds of the latter.1, 14, 15, 16, 17, 18 Few studies have been carried out to evaluate cross-reactivity with penicillin or other β-lactams in subjects with primary

Acknowledgements

We thank Ian Johnstone for his help with the English language version.

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    Supported by FIS grant No. 00/0838.

    ☆☆

    Reprint requests: Antonino Romano, MD, Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati, 31, 00168 Rome, Italy.

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