A statement on cefazolin immediate hypersensitivity: data from a large database, and focus on the cross-reactivities

Clin Exp Allergy. 2011 Nov;41(11):1602-8. doi: 10.1111/j.1365-2222.2011.03846.x. Epub 2011 Sep 1.


Background: More perioperative cefazolin use has resulted in an increased risk of cefazolin-associated reactions.

Objective: The aim of this article is to study immediate reactions to cefazolin and attempt to determine possible allergic cross-reactivity with other ß-lactams using data from the Drug Allergy and Hypersensitivity Database (DAHD).

Methods: All 25 cefazolin-associated reactions in the DAHD were reviewed. The cases identified were then investigated according to the European Network for Drug Allergy (ENDA) recommendations by skin testing and challenges.

Results: A total of 10 individuals with proven IgE-mediated cefazolin hypersensitivity were identified between January 1999 and July 2009. All the index reactions were compatible with an acute IgE-mediated process, six with anaphylaxis, two with systemic allergic reactions without hypotension, and two with urticaria/angioedema. Cefazolin skin tests were positive in seven individuals and cefazolin challenges were positive in three more individuals. In the eight cefazolin allergic patients who had challenges with other ß-lactams, there was no positive reaction noted.

Conclusion and clinical relevance: In this cohort of patients with IgE-mediated reactions to cefazolin, a majority tolerated amoxicillin and several patients tolerated other cephalosporins. This implies that the R1 side-chain may play an essential role in IgE-mediated reactions to cefazolin. No clear rule to predict cross-reactivity with other ß-lactams could be determined. More research on IgE-mediated hypersensitivity to cefazolin and other cephalosporins is needed.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / chemistry
  • Anti-Bacterial Agents / immunology*
  • Cefazolin / chemistry
  • Cefazolin / immunology*
  • Child
  • Cross Reactions / immunology
  • Databases, Factual
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / immunology*
  • Female
  • Humans
  • Hypersensitivity, Immediate / diagnosis
  • Hypersensitivity, Immediate / immunology*
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Skin Tests
  • Young Adult


  • Anti-Bacterial Agents
  • Cefazolin