IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of alternative cephalosporins

Antonino Romano, Francesco Gaeta, Rocco Luigi Valluzzi, Michela Maggioletti, Alessandra Zaffiro, Cristiano Caruso, Donato Quaratino

Research output: Contribution to journalArticle

Abstract

Background Studies regarding the cross-reactivity and tolerability of alternative cephalosporins in large samples of subjects with an IgE-mediated hypersensitivity to cephalosporins are lacking. Objective We sought to evaluate the possibility of using alternative cephalosporins in subjects with cephalosporin allergy who especially require them. Methods One hundred two subjects with immediate reactions to cephalosporins and positive skin test results to the responsible drugs underwent serum specific IgE assays with cefaclor and skin tests with different cephalosporins. Subjects were classified in 4 groups: group A, positive responses to 1 or more of ceftriaxone, cefuroxime, cefotaxime, cefepime, cefodizime, and ceftazidime; group B, positive responses to aminocephalosporins; group C, positive responses to cephalosporins other than those belonging to the aforementioned groups; and group D, positive responses to cephalosporins belonging to 2 different groups. Group A subjects underwent challenges with cefaclor, cefazolin, and ceftibuten; group B participants underwent challenges with cefuroxime axetil, ceftriaxone, cefazolin, and ceftibuten; and group C and D subjects underwent challenges with some of the aforementioned cephalosporins selected on the basis of their patterns of positivity. Results There were 73 subjects in group A, 13 in group B, 7 in group C, and 9 in group D. Challenges with alternative cephalosporins (ceftibuten in 101, cefazolin in 96, cefaclor in 82, and cefuroxime axetil and ceftriaxone in 22 subjects) were well tolerated. Conclusions Cephalosporin hypersensitivity does not seem to be a class hypersensitivity. Subjects with cephalosporin allergy who especially require alternative cephalosporins might be treated with compounds that have side-chain determinants different from those of the responsible cephalosporins and have negative pretreatment skin test responses.

Original languageEnglish
Pages (from-to)685-691.e3
JournalJournal of Allergy and Clinical Immunology
Volume136
Issue number3
DOIs
Publication statusPublished - Sep 1 2015

Keywords

  • Cephalosporin allergy
  • cross-reactivity
  • skin tests
  • tolerability

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Medicine(all)

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