Evaluation of immediate allergic reactions to cephalosporins in non-penicillin-allergic patients

Int Arch Allergy Immunol. 2009;150(3):205-9. doi: 10.1159/000222672. Epub 2009 Jun 3.

Abstract

Background: Cephalosporins can induce severe or life-threatening IgE-mediated reactions in some individuals. In this study, we wish to describe a group of non-penicillin-allergic patients who were evaluated for immediate allergic reactions to cephalosporins.

Methods: The patients were assessed by skin tests with the culprit cephalosporin as well as with other cephalosporins and penicillins. If indicated, oral challenge testing was performed.

Results: Six patients were assessed. A total of 42 skin tests and 20 oral challenges were performed. In 4 patients, skin tests included the causative drug; in 2 patients, the diagnosis of a cephalosporin allergy was made by skin test; in 4 patients, the diagnosis of a cephalosporin hypersensitivity was made by oral challenge. In 96.9% of the oral challenges, which were done using medications with no structural side chain similarities to the culprit drug, no adverse reaction occurred.

Conclusion: A positive skin test to cephalosporin implies the presence of drug-specific IgE antibodies. Cephalosporins without side chain similarities are suggested to patients with cephalosporin reactions and no beta-lactam reactivity.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / chemistry
  • Cephalosporins / administration & dosage
  • Cephalosporins / adverse effects*
  • Cephalosporins / chemistry
  • Child
  • Desensitization, Immunologic
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / immunology
  • Female
  • Humans
  • Hypersensitivity, Immediate / chemically induced
  • Hypersensitivity, Immediate / diagnosis*
  • Hypersensitivity, Immediate / immunology
  • Immunoglobulin E / immunology*
  • Male
  • Middle Aged
  • Penicillins / administration & dosage
  • Penicillins / adverse effects
  • Penicillins / chemistry
  • Skin Tests

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Penicillins
  • Immunoglobulin E